Individual
WANDA ROBERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
32020 1ST AVE S, SUITE 115, FEDERAL WAY, WA 98003-5717
(253) 838-6556
(253) 661-4523
Mailing address
32020 1ST AVE S, SUITE 115, FEDERAL WAY, WA 98003-5717
(253) 838-6556
(253) 661-4523
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD00018181
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RA98
REGENCE RIDER NUMBER
WA
Enumeration date
09/30/2006
Last updated
07/09/2007
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