Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000072 | WA |
N | 222Z00000X | Podiatrist | OI00000072 | WA |
Y | 224P00000X | Prosthetist | PS00000071 | WA |
NPI | 1417209040 |
---|---|
Provider Name | Mr. David Ellis Hensley |
First Address | Mountlake Terrace, WA 98043-2180 |
Second Address | Puyallup, WA 98372-3718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2012 |
Last Update Date | 18/12/2014 |