Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP30003068 | WA |
NPI | 1174587026 |
---|---|
Provider Name | Mrs. Carol Lau Otto |
First Address | Federal Way, WA 98003-4823 |
Second Address | Tacoma, WA 98405-4234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2006 |
Last Update Date | 12/07/2007 |