Provider Demographics
NPI:1063602977
Name:WEBB, JEANINE M (NAC)
Entity type:Individual
Prefix:MISS
First Name:JEANINE
Middle Name:M
Last Name:WEBB
Suffix:
Gender:F
Credentials:NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E WEDGEWOOD AVE
Mailing Address - Street 2:APT#47
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5385
Mailing Address - Country:US
Mailing Address - Phone:509-879-9598
Mailing Address - Fax:509-325-0491
Practice Address - Street 1:212 E WEDGEWOOD AVE
Practice Address - Street 2:APT#47
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5385
Practice Address - Country:US
Practice Address - Phone:509-879-9598
Practice Address - Fax:509-325-0491
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10091501376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide