Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | AP30001422 | WA |
NPI | 1013944735 |
---|---|
Provider Name | Lyell Elizabeth Fox |
First Address | Port Angeles, WA 98362-0311 |
Second Address | Port Angeles, WA 98362-3910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S77982 | (02) |