Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 00005731 | WA |
NPI | 1013592278 |
---|---|
Provider Name | Mrs. Tani Mae Weber |
First Address | Bothell, WA 98011-4803 |
Second Address | Bothell, WA 98011-4803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2021 |
Last Update Date | 09/03/2021 |