Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW61046337 | WA |
NPI | 1063040491 |
---|---|
Provider Name | Renee A Terralumina |
First Address | Onalaska, WA 98570-9627 |
Second Address | Onalaska, WA 98570-9627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2020 |
Last Update Date | 31/03/2020 |