Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH60392892 | WA |
NPI | 1003332677 |
---|---|
Provider Name | Lindsey Wisdom |
First Address | Graham, WA 98338-9442 |
Second Address | Tacoma, WA 98433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |