Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1356667703 |
---|---|
Provider Name | Sandy Lee Warner |
First Address | Kennewick, WA 99336-3128 |
Second Address | Kennewick, WA 99336-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 02/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2009158 | (05) | WA |