Provider Demographics
NPI:1598232902
Name:RAE, JOZLINN (IDMT)
Entity Type:Individual
Prefix:
First Name:JOZLINN
Middle Name:
Last Name:RAE
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 N GARRY RD
Mailing Address - Street 2:
Mailing Address - City:OTIS ORCHARDS
Mailing Address - State:WA
Mailing Address - Zip Code:99027-9397
Mailing Address - Country:US
Mailing Address - Phone:206-247-1764
Mailing Address - Fax:
Practice Address - Street 1:3710 N GARRY RD
Practice Address - Street 2:
Practice Address - City:OTIS ORCHARDS
Practice Address - State:WA
Practice Address - Zip Code:99027-9397
Practice Address - Country:US
Practice Address - Phone:206-247-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians