Healthcare Provider Details

I. General information

NPI: 1275881278
Provider Name (Legal Business Name): JESSICA ANN RENNAKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE
SPOKANE WA
99204-2803
US

IV. Provider business mailing address

13604 E 4TH AVE
SPOKANE VALLEY WA
99216-0601
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-7259
  • Fax:
Mailing address:
  • Phone: 509-368-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN00162965
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: