Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1063564946 |
---|---|
Provider Name | Joyce Rathburn |
First Address | Billings, MT 59107-5100 |
Second Address | Billings, MT 59101-0905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 11/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0550443 | (05) | MT |
103311500 | (05) | WY |