Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2448 | OR |
Y | 152W00000X | Optometrist | 3054 | WA |
N | 152W00000X | Optometrist | 858 | ID |
NPI | 1003993601 |
---|---|
Provider Name | Kelly K Malueg |
First Address | Seattle, WA 98134-1102 |
Second Address | Seattle, WA 98134-1102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 05/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2016582 | (05) | WA |
U34633 | (02) |