Provider Demographics
NPI:1790743425
Name:QUIRICONI, JENI LEE (LMP)
Entity Type:Individual
Prefix:MS
First Name:JENI
Middle Name:LEE
Last Name:QUIRICONI
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 1:1328 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3809
Mailing Address - Country:US
Mailing Address - Phone:360-751-3313
Mailing Address - Fax:360-636-5255
Practice Address - Street 1:1328 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3809
Practice Address - Country:US
Practice Address - Phone:360-751-3313
Practice Address - Fax:360-636-5255
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA12619174400000X
OR7047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7047OtherLMT LICENSE
WAMA12619OtherLMP LICENSE
WA0143135OtherLABOR & INDUSTRIES WA STA