Provider Demographics
NPI:1235350059
Name:DAVID, JESSICA R (LMT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:R
Last Name:DAVID
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6045
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227
Mailing Address - Country:US
Mailing Address - Phone:360-738-4121
Mailing Address - Fax:
Practice Address - Street 1:1155 NO. STATE STREET
Practice Address - Street 2:STE 327
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-738-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist