Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000471 | WA |
N | 122400000X | Denturist | DN34 | AZ |
NPI | 1205075785 |
---|---|
Provider Name | Miss Amy Linda Varshock |
First Address | Mount Vernon, WA 98273-2457 |
Second Address | Mount Vernon, WA 98273-2457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2009 |
Last Update Date | 15/10/2012 |