Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA60110940 | WA |
NPI | 1528358629 |
---|---|
Provider Name | Mrs. Lettia Danae Mcbride |
First Address | Colfax, WA 99111-8515 |
Second Address | Colfax, WA 99111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 11/04/2011 |