Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60670980 | WA |
NPI | 1003362088 |
---|---|
Provider Name | Marcia Rene Kucera |
First Address | Mount Vernon, WA 98273-3752 |
Second Address | Mount Vernon, WA 98273-2687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2016 |
Last Update Date | 06/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
371117 | LABOR AND INDUSTRIES (01) | WA |