Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 60867088 | WA |
NPI | 1487124905 |
---|---|
Provider Name | Laura Renee Harbaugh |
First Address | Vaughn, WA 98394-9723 |
Second Address | Gig Harbor, WA 98335-2057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 27/11/2018 |