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NPI Code Detail

MEDICARE: JEREMY GLENN NUGENT CM60686561

MEDICARE: JEREMY GLENN NUGENT CM60686561
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianCM6066561WA

General Provider Information

NPI Number : 1205793395
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY GLENN NUGENT CM60686561
Provider Business Mailing Address
First Line : 10503 CREEK ST SE UNIT 115
Second Line :
City : YELM
State : WA
Zip : 98597-8678
Country : US
Telephone Number : 360-623-8056
Fax Number : 360-623-1072
Provider Business Practice Location Address
First Line : 3510 STEELHAMMER DR
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-1532
Country : US
Telephone Number : 360-623-8056
Fax Number : 360-623-1072
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2026
Last Update Date : 01/08/2026

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Directions to “ JEREMY GLENN NUGENT CM60686561” Practice Location

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