Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW60442003 | WA |
NPI | 1043639990 |
---|---|
Provider Name | Maya Horrocks |
First Address | Port Townsend, WA 98368-6314 |
Second Address | Port Townsend, WA 98368-6314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 08/04/2014 |