Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 60215480 | WA |
Y | 213EG0000X | General Practice | 60215480 | WA |
NPI | 1003128208 |
---|---|
Provider Name | Dr. Jill Noelle Tetrick |
First Address | Bellingham, WA 98225-1735 |
Second Address | Bellingham, WA 98225-1735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 16/11/2017 |