Individual
JESSICA MARIE RADAKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3426 MARY ELDER RD, OLYMPIA, WA 98506
(360) 528-2590
Mailing address
5351 PIERCE AVE, JOINT BASE LEWIS MCCHORD, WA 98433-1139
(208) 850-9681
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60928570
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
11/19/2019
Last updated
11/19/2019
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