Individual
DAISY NOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 W PRASCH AVE, YAKIMA, WA 98902-5362
(509) 494-7900
(509) 494-7915
Mailing address
1519 N 42ND PL, MOUNT VERNON, WA 98273-9147
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81493701
—
WA
Enumeration date
05/11/2017
Last updated
05/11/2017
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