Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1164960084 |
---|---|
Provider Name | Jessi Jones-Paisley |
First Address | Boise, ID 83702-7142 |
Second Address | Boise, ID 83702-7142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2017 |
Last Update Date | 11/02/2017 |