Doctor Name: | MRS. WANETTA KING |
NPI Number: | 1366494924 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 2552-C |
Business Practice Address: | 15301 Warren Shingle Rd Beale Afb, CA - 959031907 |
Business Phone Number: | 5306343423 |
Business Fax Number: | 5306340670 |
Mailing Address: | 15301 Warren Shingle Rd, BEALE AFB |
State: | CA |
Postal Code: | 959031907 |
Phone Number: | 5306343423 |
Fax Number: | 5306340670 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 02/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | 2552-C |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |