Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | DH-2441 | ID |
Y | 124Q00000X | Dental Hygienist | DH60241153 | WA |
NPI | 1063185445 |
---|---|
Provider Name | Signe Kelsa Parent |
First Address | Spokane, WA 99202-4932 |
Second Address | Clarkston, WA 99403-2013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2021 |
Last Update Date | 30/07/2021 |