Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 000020165 | WA |
NPI | 1003324393 |
---|---|
Provider Name | Mary Ellen Walker |
First Address | Vashon, WA 98070-0389 |
Second Address | Vashon, WA 98070-0389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2018 |
Last Update Date | 20/01/2018 |