MEDICARE: MS. JENNIFER HARKESTAD

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
1	261QP0905X	State or Local Public Health Clinic/Center	RN60220109	WA

General Provider Information

NPI Number	:	1639570963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER HARKESTAD

Provider Business Mailing Address
First Line	:	9032 E SHOREWOOD DR APT 319
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3212
Country	:	US
Telephone Number	:	425-890-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	9032 E SHOREWOOD DR APT 319
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3212
Country	:	US
Telephone Number	:	425-890-2818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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