Individual
MRS. MICKI ANN SEBOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1921 1ST ST, #940, CHENEY, WA 99004-2000
(509) 939-1630
Mailing address
1921 1ST ST, #940, CHENEY, WA 99004-2000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MASS.MA.60419919
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MASS.MA.60419919
LMP
WA
Enumeration date
11/01/2013
Last updated
11/01/2013
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