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General NPI Number Information
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NPI Number | 1841600723
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Entity Type | Individual
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Provider Name | JESSICA VILA
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Gender | Female
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 3372 E JENALAN
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City | POST FALLS
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State | ID
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Zip | 83854-5158
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Country | US
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Telephone | 208-457-1314
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Fax |
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Provider Business Mailing Address
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Address Line | 416 EAST JEAN AVE
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City | SPOKANE
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State | WA
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Zip | 99217-5030
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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 | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | OTA-1287
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License Number State | ID
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