Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP60703570 | WA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP60703570 | WA |
NPI | 1063945897 |
---|---|
Provider Name | Jubilee Pearl Mattix |
First Address | Seattle, WA 98125-5691 |
Second Address | Seattle, WA 98115-3635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2017 |
Last Update Date | 17/07/2017 |