Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 43152 | WA |
NPI | 1033108360 |
---|---|
Provider Name | Leslie Houck |
First Address | Bellingham, WA 98226-7123 |
Second Address | Bellingham, WA 98226-7123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 28/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8378523 | (05) | WA |
G15818 | (02) | WA |