Doctor Name: | JENNIFER D ANDERSON |
NPI Number: | 1023454345 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | AP60300762 |
Business Practice Address: | 118 7th Ave Sw Puyallup, WA - 983716803 |
Business Phone Number: | 2535790067 |
Business Fax Number: | |
Mailing Address: | 118 7th Ave Sw, PUYALLUP |
State: | WA |
Postal Code: | 983716803 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/14/2013 |
NPI Last Update Date: | 05/14/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP60300762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |