Provider Demographics
NPI:1982914974
Name:CHRISTLIEB, JESSICA (CNA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CHRISTLIEB
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18463 BLUEBERRY LN
Mailing Address - Street 2:APT P203
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2505
Mailing Address - Country:US
Mailing Address - Phone:206-372-7994
Mailing Address - Fax:
Practice Address - Street 1:18463 BLUEBERRY LN
Practice Address - Street 2:APT P203
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2505
Practice Address - Country:US
Practice Address - Phone:206-372-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC 10091309376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide