Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00004959 | WA |
NPI | 1013483775 |
---|---|
Provider Name | Mrs. Jamesa Treadwell |
First Address | Oak Harbor, WA 98277-8400 |
Second Address | Oak Harbor, WA 98277-8400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2018 |
Last Update Date | 21/10/2018 |