Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO 00000833 | WA |
NPI | 1114310182 |
---|---|
Provider Name | Katherine Mary Ryan |
First Address | Wenatchee, WA 98801-2826 |
Second Address | Wenatchee, WA 98801-2826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2015 |
Last Update Date | 13/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000288 | (05) | WA |