Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60207531 | WA |
NPI | 1265811731 |
---|---|
Provider Name | Karyl Desneiges Huber |
First Address | Morton, WA 98356-0976 |
Second Address | Morton, WA 98356-0976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2015 |
Last Update Date | 02/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN60207531 | (05) | WA |