Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP30000477 | WA |
NPI | 1083759773 |
---|---|
Provider Name | Ms. Karen Lee |
First Address | Mount Vernon, WA 98273-3901 |
Second Address | Mount Vernon, WA 98273-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9600701 | (05) | WA |
R12735 | (02) | WA |