Individual
LACIE IRENE JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
513 E STREET, COSMOPOLIS, WA 98537
(360) 580-2845
Mailing address
PO BOX 1194, COSMOPOLIS, WA 98537
(360) 580-2845
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00024273
WA
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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