Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | AP60967896 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60967896 | WA |
NPI | 1205494291 |
---|---|
Provider Name | Mrs. Reah Ann Tobola |
First Address | University Place, WA 98466-3036 |
Second Address | University Place, WA 98466-3036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 27/05/2020 |