Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | 2153 | WA |
NPI | 1578655882 |
---|---|
Provider Name | Kristi L Wolf |
First Address | Vancouver, WA 98663-2449 |
Second Address | Portland, OR 97227-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |