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General NPI Number Information
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NPI Number | 1497859490
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Entity Type | Individual
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Provider Name | JESSICA PERTTULA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | CMR 415 BOX 4471
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City | APO
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State | AE
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Zip | 09114
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Country | DE
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Telephone | 01751934362
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 415 BOX 4471
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City | APO
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State | AE
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Zip | 09114
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Country | US
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Telephone |
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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 | 374700000X
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Taxonomy Name | Technician
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License Number | B1500747
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License Number State | TX
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