Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA13753 | WA |
NPI | 1760606107 |
---|---|
Provider Name | Mrs. Sarah D Jenkins |
First Address | Roy, WA 98580-0581 |
Second Address | Tacoma, WA 98406-4939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1352JE | REGENCE (01) | WA |
135548 | LABOR AND INDUSTRIES (01) | WA |