Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI60984768 | WA |
N | 222Z00000X | Podiatrist | OI60984768 | WA |
Y | 224P00000X | Prosthetist | WA |
NPI | 1376167247 |
---|---|
Provider Name | Miss Terese Jenks |
First Address | Olympia, WA 98506-5218 |
Second Address | Olympia, WA 98506-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2020 |
Last Update Date | 05/06/2020 |