Provider Demographics
NPI:1508052754
Name:MAINOR, JAMILA NIA (MD)
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:NIA
Last Name:MAINOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMILA
Other - Middle Name:NIA
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-397-1704
Mailing Address - Fax:425-335-5145
Practice Address - Street 1:8910 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2400
Practice Address - Country:US
Practice Address - Phone:425-397-1704
Practice Address - Fax:425-335-5145
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003245207Q00000X
FLME126189207Q00000X
WAMD61215438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2210571Medicaid