Healthcare Provider Details

I. General information

NPI: 1265240410
Provider Name (Legal Business Name): JESSIE MAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13810 SOMERSET LN SE
BELLEVUE WA
98006-2267
US

IV. Provider business mailing address

13810 SOMERSET LN SE
BELLEVUE WA
98006-2267
US

V. Phone/Fax

Practice location:
  • Phone: 206-446-4264
  • Fax:
Mailing address:
  • Phone: 206-446-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberRN61057681
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95271718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: