Provider Demographics
NPI:1427570134
Name:JETT, DOLLYLEE (LMP, RN, PHDC)
Entity Type:Individual
Prefix:
First Name:DOLLYLEE
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:LMP, RN, PHDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 COLBY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2994
Mailing Address - Country:US
Mailing Address - Phone:425-418-3330
Mailing Address - Fax:
Practice Address - Street 1:2520 COLBY AVE STE 112
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2994
Practice Address - Country:US
Practice Address - Phone:425-418-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60534495163W00000X
WAMA60607081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse