Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | TP61099840 | WA |
NPI | 1225605223 |
---|---|
Provider Name | Kylie Jeanene Simmons |
First Address | Vancouver, WA 98665-8204 |
Second Address | Vancouver, WA 98665-8204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 08/06/2021 |