Healthcare Provider Details

I. General information

NPI: 1053605600
Provider Name (Legal Business Name): JENNIFER N PENSE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER N SEELEY

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 31ST AVE SW STE C
PUYALLUP WA
98373-3723
US

IV. Provider business mailing address

3908 10TH ST SE
PUYALLUP WA
98374-2188
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-5951
  • Fax: 253-845-7073
Mailing address:
  • Phone: 253-848-5951
  • Fax: 253-845-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60384424
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: