Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP60803543 | WA |
NPI | 1003328485 |
---|---|
Provider Name | Noah Burton Dassel |
First Address | Seattle, WA 98144-2518 |
Second Address | Seattle, WA 98144-2518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 25/10/2017 |