Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00005865 | WA |
NPI | 1063044477 |
---|---|
Provider Name | Stella Aragon Poe |
First Address | Port Townsend, WA 98368-2443 |
Second Address | Port Townsend, WA 98368-2443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2020 |
Last Update Date | 04/02/2020 |