Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW 60650687 | WA |
NPI | 1003368515 |
---|---|
Provider Name | Leanna Badillo |
First Address | Sedro Woolley, WA 98284-8371 |
Second Address | Sedro Woolley, WA 98284-8371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2016 |
Last Update Date | 31/10/2016 |