Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 6800 | WA |
NPI | 1003836586 |
---|---|
Provider Name | Kathleen A Stambaugh |
First Address | Burlington, WA 98233-3125 |
Second Address | Burlington, WA 98233-3125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |