Provider Demographics
NPI:1770021701
Name:SOINE, JESSICA SOLVEJG (LMT, NTP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SOLVEJG
Last Name:SOINE
Suffix:
Gender:F
Credentials:LMT, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3645
Mailing Address - Country:US
Mailing Address - Phone:208-720-5757
Mailing Address - Fax:
Practice Address - Street 1:2320 RANCH RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3645
Practice Address - Country:US
Practice Address - Phone:208-720-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0001619133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist