Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP30002497 | WA |
NPI | 1023233509 |
---|---|
Provider Name | Ms. Sally Alice Hutton |
First Address | Tonasket, WA 98855-1192 |
Second Address | Omak, WA 98841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |