Individual
JERRY EZELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
194 PORTER RD, KALAMA, WA 98625-9698
(360) 673-3488
Mailing address
194 PORTER RD, KALAMA, WA 98625-9698
(360) 673-3488
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
RN60545703
WA
Other
Enumeration date
04/21/2015
Last updated
04/21/2015
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