Healthcare Provider Details

I. General information

NPI: 1912396789
Provider Name (Legal Business Name): AURORA JENEANE-MARIE JEWELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 PACIFIC AVE S
TACOMA WA
98444-5525
US

IV. Provider business mailing address

1019 PACIFIC AVE STE 300
TACOMA WA
98402-4488
US

V. Phone/Fax

Practice location:
  • Phone: 253-536-2020
  • Fax: 253-536-5327
Mailing address:
  • Phone: 253-597-4550
  • Fax: 253-722-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60505836
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: