Healthcare Provider Details

I. General information

NPI: 1811294598
Provider Name (Legal Business Name): JENNIFER MUIR CO, LO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER NACK

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4139
US

IV. Provider business mailing address

723 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4139
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-7478
  • Fax: 253-593-7980
Mailing address:
  • Phone: 253-572-7478
  • Fax: 253-593-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: