Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 2405 | OR |
NPI | 1861758955 |
---|---|
Provider Name | Ms. Debra King |
First Address | Vancouver, WA 98665-5716 |
Second Address | Vancouver, WA 98665-5716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 03/04/2012 |