Provider Demographics
NPI:1912313479
Name:NEWBILL, JESSICA (LMP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NEWBILL
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 1:2720 QUARRY BROWNS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-9633
Mailing Address - Country:US
Mailing Address - Phone:509-294-8031
Mailing Address - Fax:
Practice Address - Street 1:306 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8962
Practice Address - Country:US
Practice Address - Phone:509-935-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60291675225700000X
WANC 60018443376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide