Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A8072 | CA |
Y | 207Q00000X | Family Doctor | OP60261412 | WA |
NPI | 1235108978 |
---|---|
Provider Name | Dr. Jeanne L. Rupert |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
292264 | LABOR & INDUSTRIES (01) | WA |
H72232 | (02) | CA |