Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 60389139 | WA |
NPI | 1225782428 |
---|---|
Provider Name | Ms. Mckenzie Jolie Ann Bennett |
First Address | Tacoma, WA 98445-2733 |
Second Address | Tacoma, WA 98445-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2022 |
Last Update Date | 07/02/2022 |