Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD00043457 | WA |
NPI | 1083607014 |
---|---|
Provider Name | Laura J Davis |
First Address | Vancouver, WA 98686-6418 |
Second Address | Vancouver, WA 98686-6418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 29/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H61167 | (02) | WA |