Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH60303163 | WA |
NPI | 1083044788 |
---|---|
Provider Name | Kaitlin Jackman |
First Address | Yakima, WA 98902-2473 |
Second Address | Ellensburg, WA 98926-8392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2013 |
Last Update Date | 15/11/2013 |