Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | OI00000178 | WA |
Y | 222Z00000X | Podiatrist | OI00000178 | WA |
NPI | 1003008137 |
---|---|
Provider Name | Miss Grace Fredeen |
First Address | Seattle, WA 98122-5395 |
Second Address | Seattle, WA 98122-5395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 13/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9036963 | (05) | WA |