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General NPI Number Information
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NPI Number | 1265240410
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Entity Type | Individual
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Provider Name | JESSIE MAR RN
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 13810 SOMERSET LN SE
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City | BELLEVUE
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State | WA
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Zip | 98006-2267
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Country | US
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Telephone | 206-446-4264
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Fax |
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Provider Business Mailing Address
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Address Line | 13810 SOMERSET LN SE
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City | BELLEVUE
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State | WA
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Zip | 98006-2267
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Country | US
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Telephone | 206-446-4264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0100X
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Taxonomy Name | Gastroenterology Registered Nurse
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License Number | RN61057681
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 95271718
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License Number State | CA
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