Healthcare Provider Details

I. General information

NPI: 1609433572
Provider Name (Legal Business Name): JENNYLYNN F PALISOC ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date: 07/22/2019
Reactivation Date: 07/29/2019

III. Provider practice location address

325 E PIONEER
PUYALLUP WA
98372-3265
US

IV. Provider business mailing address

325 E PIONEER
PUYALLUP WA
98372-3265
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60223177
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60962323
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: