Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D010180 | AZ |
Y | 213EG0000X | General Practice | D010180 | AZ |
N | 1223G0001X | General Practice | DE60751447 | WA |
N | 213EG0000X | General Practice | DE60751447 | WA |
NPI | 1003275546 |
---|---|
Provider Name | Jessica Lynne Giles |
First Address | Phoenix, AZ 85012-2908 |
Second Address | Phoenix, AZ 85033-5700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2016 |
Last Update Date | 27/04/2021 |