Healthcare Provider Details

I. General information

NPI: 1407827850
Provider Name (Legal Business Name): VESNA JAMBORCIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W 1ST AVE
TOPPENISH WA
98948-1564
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-5600
  • Fax:
Mailing address:
  • Phone: 425-493-6001
  • Fax: 425-493-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11075
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60593180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: