Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 14733 | OR |
NPI | 1073568762 |
---|---|
Provider Name | Dr. Kristi J Jett |
First Address | Bend, OR 97701 |
Second Address | Bend, OR 97701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176792 | (05) | OR |
C94375 | (02) |