Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | WA |
NPI | 1316691090 |
---|---|
Provider Name | Mr. William M Jenkins |
First Address | Seattle, WA 98101-3245 |
Second Address | Seattle, WA 98101-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |