Individual
JODY WELCKER PROVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
219 CEDAR AVE S, NORTH BEND, WA 98045-8262
(425) 888-2129
Mailing address
219 CEDAR AVE S, NORTH BEND, WA 98045-8262
(425) 888-2129
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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