Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | DH-1722-RST | ID |
Y | 124Q00000X | Dental Hygienist | DH60263001 | WA |
NPI | 1023509205 |
---|---|
Provider Name | Rebecca Jo Bosh |
First Address | Bellingham, WA 98225-4642 |
Second Address | Bellingham, WA 98225-4642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2018 |
Last Update Date | 23/05/2018 |