Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP30005772 | WA |
NPI | 1174568778 |
---|---|
Provider Name | Kathleen Mary Aycock |
First Address | Everett, WA 98201-1409 |
Second Address | Everett, WA 98201-4168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 30/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P27014 | (02) | WA |