Individual
SALOME ODJA DOCKENDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 PACIFIC AVE STE 19501201, TACOMA, WA 98402-4301
(812) 870-6728
Mailing address
5150 NW WHISPER ST, SILVERDALE, WA 98383-8338
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP61008318
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003467127
—
WA
Enumeration date
09/20/2019
Last updated
11/23/2019
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