Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60153160 | WA |
NPI | 1295299113 |
---|---|
Provider Name | Ms. Stephanie Jean Hemenway |
First Address | Morton, WA 98356 |
Second Address | Morton, WA 98356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2019 |
Last Update Date | 24/01/2019 |