Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | D1 60075309 | WA |
NPI | 1376949487 |
---|---|
Provider Name | Kristine Remmerde |
First Address | Vancouver, WA 98686-1448 |
Second Address | Vancouver, WA 98686-1448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2014 |
Last Update Date | 17/11/2014 |