Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00046586 | WA |
N | 207ND0900X | Dermatopathologist | MD00046586 | WA |
N | 207NS0135X | Procedural Dermatology | MD00046586 | WA |
NPI | 1316962111 |
---|---|
Provider Name | Mrs. Tanya Rosanne Hathaway |
First Address | Seattle, WA 98122-4201 |
Second Address | Seattle, WA 98101-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 23/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007587 | (05) | WA |
MD00046586 | MEDICAL LICENSE NUMBER (01) | WA |