Individual
JENNIFER L KANNBERG NYBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003906
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0189397
DEPARTMENT OF L & I
WA
05
—
2029510
—
WA
01
—
753021696
PREMERA BLUE CROSS
WA
01
—
9457KA
REGENCE BLUESHIELD
WA
Enumeration date
05/31/2006
Last updated
04/22/2021
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