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General NPI Number Information
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NPI Number | 1457647091
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Entity Type | Individual
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Provider Name | JESSICA CHRISTINE GERMINO MD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 825 EASTLAKE AVE E
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City | SEATTLE
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State | WA
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Zip | 98109-4405
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Country | US
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Telephone | 206-288-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 938 NW KINGS BLVD
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City | CORVALLIS
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State | OR
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Zip | 97330-2505
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Country | US
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Telephone | 541-758-5407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD180785
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License Number State | OR
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