Provider Demographics
NPI:1992132047
Name:CAIN, JIMIA RAE
Entity type:Individual
Prefix:MS
First Name:JIMIA
Middle Name:RAE
Last Name:CAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N MORAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2905
Mailing Address - Country:US
Mailing Address - Phone:509-222-4017
Mailing Address - Fax:
Practice Address - Street 1:100 N MORAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2905
Practice Address - Country:US
Practice Address - Phone:509-222-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603326887175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath