Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 128679 | CA |
Y | 208000000X | Pediatrician | MD60575925 | WA |
NPI | 1003230814 |
---|---|
Provider Name | Dr. Jenna Eve Holmen |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-4379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2014 |
Last Update Date | 26/09/2016 |