Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP30003025 | WA |
NPI | 1376625822 |
---|---|
Provider Name | Mrs. Cheryl Rose Lienesch |
First Address | Auburn, WA 98071-0430 |
Second Address | Renton, WA 98055-5714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9612029 | (05) | WA |