Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OP60663768 | WA |
NPI | 1003294190 |
---|---|
Provider Name | Mrs. Anne Garces Laporte |
First Address | Tacoma, WA 98405-4265 |
Second Address | Tacoma, WA 98405-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 26/04/2021 |