Provider Demographics
NPI:1548402175
Name:WILIE, JENEFER LEE (LMP)
Entity Type:Individual
Prefix:
First Name:JENEFER
Middle Name:LEE
Last Name:WILIE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 N MULLAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4094
Mailing Address - Country:US
Mailing Address - Phone:509-928-8550
Mailing Address - Fax:509-928-8592
Practice Address - Street 1:826 N MULLAN RD STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4094
Practice Address - Country:US
Practice Address - Phone:509-928-8550
Practice Address - Fax:509-928-8592
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60065995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist