Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | AP30007071 | WA |
NPI | 1003859638 |
---|---|
Provider Name | Sandra A. Conner |
First Address | Airway Heights, WA 99001 |
Second Address | Airway Heights, WA 99001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 31/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9647652 | (05) | WA |
Q64131 | (02) | WA |