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General NPI Number Information
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NPI Number | 1720674948
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Entity Type | Individual
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Provider Name | CIERA MICHELLE AUZENNE
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Gender | Female
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Dates
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Enumeration Date | 12/13/2020
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 6700 MARTIN WAY E STE 117
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City | OLYMPIA
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State | WA
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Zip | 98516-5586
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Country | US
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Telephone | 360-413-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 3012 HAMPTON DR SW
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City | TUMWATER
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State | WA
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Zip | 98512-6258
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Country | US
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Telephone | 360-789-3365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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