Individual
JESSICA T LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
900 NE 139TH ST, SUITE 202, VANCOUVER, WA 98685-2513
(360) 566-9355
(360) 816-1327
Mailing address
900 NE 139TH ST, SUITE 202, VANCOUVER, WA 98685-2513
(360) 566-9355
(360) 816-1327
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD26964
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275535
—
OR
Enumeration date
06/04/2006
Last updated
11/06/2015
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