Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00004908 | WA |
NPI | 1043221211 |
---|---|
Provider Name | Joan Pavey |
First Address | Tacoma, WA 98421-1108 |
Second Address | Tacoma, WA 98421-1108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5901863 | (05) | WA |