Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1023622727 |
---|---|
Provider Name | Serenity Quiggle |
First Address | Vancouver, WA 98665-6628 |
Second Address | Vancouver, WA 98665-0697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 01/09/2020 |