Healthcare Provider Details

I. General information

NPI: 1184265316
Provider Name (Legal Business Name): JESSECA WANG ESKANDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2019
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 80TH ST NE
MARYSVILLE WA
98270-3427
US

IV. Provider business mailing address

4404 80TH ST NE
MARYSVILLE WA
98270-3427
US

V. Phone/Fax

Practice location:
  • Phone: 360-659-1231
  • Fax:
Mailing address:
  • Phone: 360-659-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95010440
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61068735
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: