Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 00004393 | WA |
NPI | 1003291527 |
---|---|
Provider Name | Mrs. Jennifer Ficco |
First Address | Vancouver, WA 98685-1607 |
Second Address | Vancouver, WA 98685-2837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2015 |
Last Update Date | 27/07/2015 |