Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO60136514 | WA |
NPI | 1104285311 |
---|---|
Provider Name | Mrs. Rachel Crites |
First Address | Ellensburg, WA 98926-3363 |
Second Address | Ellensburg, WA 98926-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2016 |
Last Update Date | 16/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47-4188629 | TAX ID (01) | WA |
603510963 | UBI (01) | WA |