Provider Demographics
NPI:1457047755
Name:WEBB, JAMAKAH J (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:JAMAKAH
Middle Name:J
Last Name:WEBB
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CHERYL LN APT 14
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-8702
Mailing Address - Country:US
Mailing Address - Phone:910-209-3367
Mailing Address - Fax:
Practice Address - Street 1:130 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1829
Practice Address - Country:US
Practice Address - Phone:910-209-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC78287335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier