Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD126254 | OR |
N | 111NI0900X | Internist | MD126254 | OR |
N | 207R00000X | Internist | MD60376605 | WA |
N | 111NI0900X | Internist | MD60376605 | WA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD60376605 | WA |
NPI | 1013128651 |
---|---|
Provider Name | Dr. Jessica Allison Brzana |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Issaquah, WA 98029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 29/06/2018 |