Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | WA |
NPI | 1063635498 |
---|---|
Provider Name | Mrs. Toni Renay Conrads |
First Address | Issaquah, WA 98029 |
Second Address | Issaquah, WA 98029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |