Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN0033 | WA |
NPI | 1700960978 |
---|---|
Provider Name | Julie Grace Stone |
First Address | Olympia, WA 98502-1110 |
Second Address | Olympia, WA 98502-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5021563 | (05) | WA |
5040498 | (05) | WA |