Individual
JESSAMINE MICHELLE MAIBEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19400 NW EVERGREEN PKWY, HILLSBORO, OR 97124-7031
(503) 690-5005
Mailing address
906 CRESTVIEW DR, NEWBERG, OR 97132-1239
(503) 267-1347
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
Primary
—
—
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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