Individual
LADY-DIAESHA LATIESH MIDDLETON-BENJAMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
7214 NE 155TH ST, KENMORE, WA 98028-4637
(206) 617-4492
Mailing address
7214 NE 155TH ST, KENMORE, WA 98028-4637
(206) 617-4492
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00050451
WA
Other
Enumeration date
12/26/2012
Last updated
12/26/2012
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