Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1023303039 |
---|---|
Provider Name | Ms. Rhonda Lee Grantham |
First Address | Olympia, WA 98506-4632 |
Second Address | Olympia, WA 98506-4436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 17/06/2011 |