Healthcare Provider Details

I. General information

NPI: 1780507921
Provider Name (Legal Business Name): JENNIFER GRACE SIMPSON RN,CBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 WARNER DR STE B
LEWISTON ID
83501-4441
US

IV. Provider business mailing address

1458 HILLCREST WAY
CLARKSTON WA
99403-2933
US

V. Phone/Fax

Practice location:
  • Phone: 509-552-9927
  • Fax:
Mailing address:
  • Phone: 509-780-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number46952
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: