Individual
MS. JACKI L STRADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
109 RAINIER AVENUE SOUTH, SUITE C, EATONVILLE, WA 98328-0546
(360) 832-6200
Mailing address
PO BOX 911, MILTON, WA 98354-0911
(253) 530-7819
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00009325
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109448
STATE L&I
WA
01
—
5586ST
REGENCE PROVIDER
WA
Enumeration date
05/30/2007
Last updated
07/08/2007
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