Provider Demographics
NPI:1174768329
Name:MULDER, JESSICA D (LMP)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:D
Last Name:MULDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9413 NE HIGHWAY 99
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8947
Mailing Address - Country:US
Mailing Address - Phone:136-071-9934
Mailing Address - Fax:
Practice Address - Street 1:9413 NE HIGHWAY 99
Practice Address - Street 2:SUITE 1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8947
Practice Address - Country:US
Practice Address - Phone:136-071-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60031942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist