Provider Demographics
NPI:1487796660
Name:DOWNS, JESSICA DIANE (LMP)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:DIANE
Last Name:DOWNS
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 1:5809 NE MINDER RD
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8857
Mailing Address - Country:US
Mailing Address - Phone:360-265-5679
Mailing Address - Fax:
Practice Address - Street 1:4569 LYNWOOD CENTER RD NE
Practice Address - Street 2:SUITE # 12
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2238
Practice Address - Country:US
Practice Address - Phone:206-780-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist