Healthcare Provider Details

I. General information

NPI: 1740330182
Provider Name (Legal Business Name): JENNIFER LYNN DEVAULT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 17TH AVE MOTHER JOSEPH CLINIC
SEATTLE WA
98122-5711
US

IV. Provider business mailing address

4048 140TH AVE NE
BELLEVUE WA
98005-1128
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-6656
  • Fax:
Mailing address:
  • Phone: 425-497-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00079741
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: