Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD00041217 | WA |
NPI | 1073583878 |
---|---|
Provider Name | Jennifer L Soden |
First Address | Vancouver, WA 98664-1989 |
Second Address | Vancouver, WA 98664-1989 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 05/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8316689 | (05) | WA |