Healthcare Provider Details

I. General information

NPI: 1659309235
Provider Name (Legal Business Name): JENNIFER LYNN SIMPSON-MANSKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DEYE LANE
EASTSOUND WA
98245
US

IV. Provider business mailing address

7 DEYE LANE
EASTSOUND WA
98245
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-2561
  • Fax: 360-466-6139
Mailing address:
  • Phone: 360-376-2561
  • Fax: 360-466-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2007-0744
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: