Provider Demographics
NPI:1780304485
Name:PONCE, JOSEFINA SILVA
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:SILVA
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S LOUISIANA ST A120 KENNEWICK, WA 99336
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99335
Mailing Address - Country:US
Mailing Address - Phone:509-491-1944
Mailing Address - Fax:
Practice Address - Street 1:35 S LOUISIANA ST STE A120
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8630
Practice Address - Country:US
Practice Address - Phone:509-491-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61352536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily