Healthcare Provider Details

I. General information

NPI: 1316149974
Provider Name (Legal Business Name): JENNIFER E. UTTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16700 177TH AVE SE
MONROE WA
98272-9141
US

IV. Provider business mailing address

1286 MOUNT BAKER RD STE B102
EASTSOUND WA
98245-8931
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-2827
  • Fax: 360-794-2741
Mailing address:
  • Phone: 360-376-7778
  • Fax: 360-376-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003279
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: