Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 55307 | MN |
N | 111NI0900X | Internist | 55307 | MN |
N | 207RH0003X | Hematology & Oncology | 55307 | MN |
Y | 207RH0003X | Hematology & Oncology | 60729673 | WA |
NPI | 1053605261 |
---|---|
Provider Name | Livia T Hegerova |
First Address | Seattle, WA 98104 |
Second Address | Seattle, WA 98122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |