Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO60335896 | WA |
NPI | 1124526900 |
---|---|
Provider Name | Melanie Lynn Duncan |
First Address | Puyallup, WA 98373-3722 |
Second Address | Puyallup, WA 98373-3722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 26/01/2018 |