| NPI | 1720501760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL M GLENN Owner 360-907-7534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036118838) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| 207QS1201X Family Medicine Sleep Medicine | |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 207RS0012X Internal Medicine Sleep Medicine | |
| 207Y00000X Otolaryngology | |
| 207YS0012X Otolaryngology Sleep Medicine | |
| 2084S0012X Psychiatry & Neurology Sleep Medicine (Licence: IN 01067650) | |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2024-01-12 |