Healthcare Provider Details

I. General information

NPI: 1801311865
Provider Name (Legal Business Name): JENNA M BULLER NOFZIGER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA M BULLER NOFZIGER ARNP

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S OTHELLO ST
SEATTLE WA
98118-3510
US

IV. Provider business mailing address

4313 S WEBSTER ST UNIT B
SEATTLE WA
98118-4156
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax: 206-788-3521
Mailing address:
  • Phone: 419-306-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60392632
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60781225
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: