Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD60974578 | WA |
NPI | 1447678206 |
---|---|
Provider Name | Marianne Emmanuelle Dubard-Gault |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98109-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2014 |
Last Update Date | 05/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1447678206 | (05) | WA |