Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN00091681 | WA |
NPI | 1053479030 |
---|---|
Provider Name | Wendy Ann White |
First Address | Port Townsend, WA 98368-2439 |
Second Address | Port Townsend, WA 98368-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7311707 | (05) | WA |
A07991 | (02) | WA |
BJ5055721 | DEA (01) | WA |