Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
N | 175F00000X | Naturopath | NT60601419 | WA |
Y | 207Q00000X | Family Doctor | NT60601419 | WA |
NPI | 1164824900 |
---|---|
Provider Name | Jelina Ip |
First Address | Tempe, AZ 85282-3014 |
Second Address | Tempe, AZ 85282-3014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 04/11/2015 |