Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PS 60371032 | WA |
NPI | 1003241563 |
---|---|
Provider Name | Russell Miller |
First Address | Olympia, WA 98506-5218 |
Second Address | Olympia, WA 98506-5218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 03/09/2013 |