Healthcare Provider Details

I. General information

NPI: 1306240890
Provider Name (Legal Business Name): JENNA NOELLE MADEJA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22610 SE 240TH ST STE 100
MAPLE VALLEY WA
98038-5086
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3400
  • Fax: 425-690-0600
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60574049
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: