MEDICARE: JENNIFER WASHBURN AGNP

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	363LG0600X	Gerontology Nurse Practitioner	44289	WY

General Provider Information

NPI Number	:	1770417891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WASHBURN AGNP

Provider Business Mailing Address
First Line	:	1510 HACKNEY DR
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 HACKNEY DR
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5001
Country	:	US
Telephone Number	:	307-399-9004
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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