Healthcare Provider Details

I. General information

NPI: 1689301905
Provider Name (Legal Business Name): JENINE ANN RECTOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENINE LAUGHEAD FNP

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 YAUGER WAY SW STE 100
OLYMPIA WA
98502-8152
US

IV. Provider business mailing address

404 YAUGER WAY SW STE 100
OLYMPIA WA
98502-8152
US

V. Phone/Fax

Practice location:
  • Phone: 564-669-5150
  • Fax:
Mailing address:
  • Phone: 564-669-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61454927
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: