Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | AP30006988 | WA |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP30006988 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60005736 | WA |
NPI | 1013944339 |
---|---|
Provider Name | Mrs. Rita Kathryn Wise |
First Address | Sequim, WA 98382-7573 |
Second Address | Sequim, WA 98382-7573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S82122 | (02) |