Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM504 | CA |
NPI | 1164948170 |
---|---|
Provider Name | Penelope Jupiter Zela |
First Address | Kirkland, WA 98033-4322 |
Second Address | Kirkland, WA 98033-4322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2017 |
Last Update Date | 08/07/2019 |