Healthcare Provider Details

I. General information

NPI: 1295989283
Provider Name (Legal Business Name): JENNIFER MARIE LYNN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 116TH AVE NE STE 950
BELLEVUE WA
98004-3832
US

IV. Provider business mailing address

1231 116TH AVE NE STE 950
BELLEVUE WA
98004-3832
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-3366
  • Fax: 425-646-5198
Mailing address:
  • Phone: 425-454-3366
  • Fax: 425-646-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP60048473
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP60048473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: