Healthcare Provider Details

I. General information

NPI: 1629995147
Provider Name (Legal Business Name): JONESSA WIEDENMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4912 82ND AVE SE
OLYMPIA WA
98501-9675
US

IV. Provider business mailing address

4912 82ND AVE SE
OLYMPIA WA
98501-9675
US

V. Phone/Fax

Practice location:
  • Phone: 360-878-1624
  • Fax:
Mailing address:
  • Phone: 360-878-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberMAPC.PC.70107640
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: