Healthcare Provider Details

I. General information

NPI: 1700102910
Provider Name (Legal Business Name): JERI S DONAHUE ARNP NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4614
US

IV. Provider business mailing address

2901 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4614
US

V. Phone/Fax

Practice location:
  • Phone: 253-534-7000
  • Fax:
Mailing address:
  • Phone: 253-534-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60151024
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: