Provider Demographics
NPI:1942814165
Name:SPIKES, JUTTA
Entity Type:Individual
Prefix:
First Name:JUTTA
Middle Name:
Last Name:SPIKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUTTA
Other - Middle Name:
Other - Last Name:RIEHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7052 PRISM ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5160
Mailing Address - Country:US
Mailing Address - Phone:360-292-8479
Mailing Address - Fax:
Practice Address - Street 1:1212 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4212
Practice Address - Country:US
Practice Address - Phone:360-918-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60051630163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant