Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | D160562836 | WA |
NPI | 1346892759 |
---|---|
Provider Name | Miss Rebecca Olmsted |
First Address | Vancouver, WA 98683-9710 |
Second Address | Vancouver, WA 98686-1448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2019 |
Last Update Date | 15/07/2019 |