Healthcare Provider Details

I. General information

NPI: 1467440693
Provider Name (Legal Business Name): JESSIE H. AHRONI PHD, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 130TH ST SE
EVERETT WA
98208-6400
US

IV. Provider business mailing address

3824 NE 155TH ST
LAKE FOREST PARK WA
98155-7738
US

V. Phone/Fax

Practice location:
  • Phone: 425-385-2263
  • Fax: 425-385-8476
Mailing address:
  • Phone: 206-365-1234
  • Fax: 526-385-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30001768
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: