Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60696752 | WA |
NPI | 1003364282 |
---|---|
Provider Name | Kathrine Omalley |
First Address | Spokane Valley, WA 99216-1043 |
Second Address | Spokane Valley, WA 99216-1043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 15/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP60696752 | WASHINGTON STATE DEPARTMENT OF HEALTH (01) | WA |