Provider Demographics
NPI:1447496955
Name:RIFKIND, JILLIAN REBECCA (EAMP)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:REBECCA
Last Name:RIFKIND
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65004
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-0004
Mailing Address - Country:US
Mailing Address - Phone:661-478-8250
Mailing Address - Fax:
Practice Address - Street 1:9481 OAK BAY RD
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-9801
Practice Address - Country:US
Practice Address - Phone:661-478-8250
Practice Address - Fax:206-238-8145
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60414217171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXDP154A23407OtherANTHEM BLUE CROSS