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NPI Profile for WEBSTER D SLACK JR in LAKESIDE, CA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
General Practice |
163WG0000X |
| NPI # | 1104582246 |
|
| Status | Active | |
| Credentials | RN (Registered Nurse) | |
| Entity | Individual | |
| Enumeration date | 11/12/2021 | |
| Last updated | 11/12/2021 - About 5 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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WEBSTER D SLACK JR
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WEBSTER D SLACK JR, RN