Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 00042289 | WA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD00042289 | WA |
NPI | 1043259856 |
---|---|
Provider Name | Dr. Jennifer Lynn Reichel |
First Address | Seattle, WA 98133-8967 |
Second Address | Seattle, WA 98133-8540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H81442 | (02) | WA |
P00330265 | RR MEDICARE (01) |