Healthcare Provider Details

I. General information

NPI: 1083808182
Provider Name (Legal Business Name): MARSHALL JONATHON SAIPHER ANP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 S SCHEUBER RD
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

11120 NE 33RD PL STE 202
BELLEVUE WA
98004-1444
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-9384
  • Fax:
Mailing address:
  • Phone: 206-823-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP.61309239-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: