Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA00018332 | WA |
NPI | 1538238654 |
---|---|
Provider Name | Staci Lay |
First Address | Eatonville, WA 98328-1701 |
Second Address | Bonney Lake, WA 98391-8457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 01/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
601736801 | UBI (01) | WA |