Healthcare Provider Details

I. General information

NPI: 1316414170
Provider Name (Legal Business Name): JAQUELINE MANJARREZ DELGADO RN, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAQUELINE MANJARREZ

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34515 9TH AVE S
FEDERAL WAY WA
98003-6761
US

IV. Provider business mailing address

32223 2ND AVE SW
FEDERAL WAY WA
98023-5603
US

V. Phone/Fax

Practice location:
  • Phone: 253-835-8100
  • Fax:
Mailing address:
  • Phone: 509-759-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN60431291
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: