Healthcare Provider Details

I. General information

NPI: 1144553819
Provider Name (Legal Business Name): ASHLEY M JENSEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY M CRANE ARNP

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 3
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 3
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7503
  • Fax: 253-272-0419
Mailing address:
  • Phone: 253-274-7503
  • Fax: 253-272-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberAP60100984
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60100984
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: