Healthcare Provider Details

I. General information

NPI: 1396951943
Provider Name (Legal Business Name): JAMMIE ELIZABETH MENETREY DO, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S 13TH ST STE 300
MOUNT VERNON WA
98274-4100
US

IV. Provider business mailing address

1400 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-9757
  • Fax: 360-814-5237
Mailing address:
  • Phone: 360-814-2500
  • Fax: 360-445-8592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS015706
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOP61166749
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: