Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 4301097343 | MI |
Y | 207VX0201X | Gynecologic Oncologist | MD60284903 | WA |
NPI | 1144497728 |
---|---|
Provider Name | Marisa Dahlman |
First Address | Federal Way, WA 98003-6208 |
Second Address | Federal Way, WA 98003-6208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 24/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0299295 | LABOR & INDUSTRY (01) | WA |
1144497728 | (05) | WA |
P01131160 | RAILROAD MEDICARE (01) | WA |