Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP60312436 | WA |
NPI | 1912245333 |
---|---|
Provider Name | Kalista H Dubiel |
First Address | Spokane Valley, WA 99216-1092 |
Second Address | Spokane Valley, WA 99216-1092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2013 |
Last Update Date | 10/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD2776815 | DEA (01) | WA |