Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW60844376 | WA |
NPI | 1003300245 |
---|---|
Provider Name | Mallorie J Kirsch |
First Address | Sequim, WA 98382-7579 |
Second Address | Sequim, WA 98382-7579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 20/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MW60844376 | WASHINGTON STATE DEPARTMENT OF HEALTH (01) | WA |