Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW61098063 | WA |
NPI | 1144897968 |
---|---|
Provider Name | Katelyn Danielle Costley |
First Address | Vashon, WA 98070-0343 |
Second Address | Vashon, WA 98070-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2021 |
Last Update Date | 09/06/2021 |