Healthcare Provider Details

I. General information

NPI: 1821934803
Provider Name (Legal Business Name): JENNIFER LYNN HAROLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18508 IVAN ST SW
ROCHESTER WA
98579-8781
US

IV. Provider business mailing address

18508 IVAN ST SW
ROCHESTER WA
98579-8781
US

V. Phone/Fax

Practice location:
  • Phone: 360-999-6792
  • Fax:
Mailing address:
  • Phone: 360-999-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70164584NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: