MEDICARE: DANA LYNNE AGUILAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	MA 00022700	WA

General Provider Information

NPI Number	:	1629229679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LYNNE AGUILAR

Provider Business Mailing Address
First Line	:	9925 214TH AVE E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-3910
Country	:	US
Telephone Number	:	253-862-6662
Fax Number	:

Provider Business Practice Location Address
First Line	:	9925 214TH AVE E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-3910
Country	:	US
Telephone Number	:	253-862-6662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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Directions to “ DANA LYNNE AGUILAR ” Practice Location

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