Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | OS 00000016 | WA |
NPI | 1164580270 |
---|---|
Provider Name | Rebecca Sue Erickson |
First Address | Seattle, WA 98101-1749 |
Second Address | Seattle, WA 98101-1749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 07/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9111006 | (05) | WA |