Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 61109132 | WA |
NPI | 1063096790 |
---|---|
Provider Name | Jordan Irene Jeffcoat |
First Address | Gig Harbor, WA 98329-8701 |
Second Address | Edmonds, WA 98026-7917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2021 |
Last Update Date | 09/05/2021 |