Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD00037546 | WA |
NPI | 1023069317 |
---|---|
Provider Name | Neeti Mittal |
First Address | Mercer Island, WA 98040-2844 |
Second Address | Mercer Island, WA 98040-2844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8254260 | (05) | WA |
H18985 | (02) | WA |