Individual
ELIZABETH BAGNULO DACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1225 HIGHLAND AVENUE, CLARKSTON, WA 99403
(509) 758-4652
Mailing address
3810 COUNTRY CLUB DR, LEWISTON, ID 83501-9678
(208) 816-8361
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
M-14192
ID
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD60843598
WA
Other
Enumeration date
04/12/2012
Last updated
09/06/2018
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