Basic Information
| Provider Information | |||||||||
| NPI: | 1285180133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAU | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2103 NORTH DIVISION ST | ||||||||
| Address2: | DENTAL CLINIC #3 | ||||||||
| City: | JOINT BASE LEWIS MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539673416 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2103 NORTH DIVISION ST | ||||||||
| Address2: | DENTAL CLINIC #3 | ||||||||
| City: | JOINT BASE LEWIS MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539673416 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2016 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH070230 | PA | Y | Dental Providers | Dental Hygienist | 124Q00000X | DHA001477 | PA | N | Dental Providers | Dental Hygienist |
No ID Information.