Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 2514 | TN |
NPI | 1043605728 |
---|---|
Provider Name | Jessica Motta Juen |
First Address | Memphis, TN 38103-8890 |
Second Address | Memphis, TN 38103-8890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 31/03/2015 |