Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000010 | WA |
N | 222Z00000X | Podiatrist | OI00000010 | WA |
Y | 224P00000X | Prosthetist | PS00000011 | WA |
NPI | 1184814154 |
---|---|
Provider Name | Mr. Wayne Daly |
First Address | Mountlake Terrace, WA 98043-2180 |
Second Address | Mountlake Terrace, WA 98043-2180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 22/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9015561 | (05) | WA |