| NPI | 1215784699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL MARIE GLENN Owner 360-907-7534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 207Y00000X Otolaryngology | |
| 207YS0012X Otolaryngology, Sleep Medicine | |
| 2084S0012X Psychiatry & Neurology, Sleep Medicine | |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-02 |