Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP30006966 | WA |
NPI | 1013912385 |
---|---|
Provider Name | Mrs. Betsy Dale Poot Poot |
First Address | Auburn, WA 98092-5929 |
Second Address | Auburn, WA 98092-5929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 09/11/2019 |