Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | AP60909320 | WA |
N | 207VX0201X | Gynecologic Oncologist | AP60909320 | WA |
NPI | 1093286536 |
---|---|
Provider Name | Mrs. Michelle Dawn Fears |
First Address | Tacoma, WA 98445-4295 |
Second Address | Puyallup, WA 98372-3750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 10/12/2018 |