Healthcare Provider Details

I. General information

NPI: 1497982359
Provider Name (Legal Business Name): JENNIFER NICOLE HOSNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 S 258TH PL #231
KENT WA
98030-6379
US

IV. Provider business mailing address

26200 PACIFIC HWY S
KENT WA
98032-6934
US

V. Phone/Fax

Practice location:
  • Phone: 360-672-0054
  • Fax:
Mailing address:
  • Phone: 253-941-4660
  • Fax: 253-946-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60071093
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60086966
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: