Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD60490776 | WA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD60490776 | WA |
N | 208000000X | Pediatrician | MD60490776 | WA |
NPI | 1265690119 |
---|---|
Provider Name | Rebecca Coleen Whitesell |
First Address | Tacoma, WA 98405-3720 |
Second Address | Tacoma, WA 98405-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 22/12/2014 |