Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA00023456 | WA |
NPI | 1467599142 |
---|---|
Provider Name | Miss Jessica Molly Gore |
First Address | Benton City, WA 99320-9529 |
Second Address | Kennewick, WA 99336-7162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |