Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP60752872 | WA |
NPI | 1023395795 |
---|---|
Provider Name | Mr. William Kevin New |
First Address | Seattle, WA 98112-4762 |
Second Address | Seattle, WA 98112-4739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2011 |
Last Update Date | 07/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
236503Y7H | (02) | DC |