Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 126800000X3 | WA |
NPI | 1285745737 |
---|---|
Provider Name | Mrs. Rhea M Christorhus |
First Address | Longview, WA 98632-3931 |
Second Address | Longview, WA 98632-3931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |