MEDICARE: JENNIFER ANDERSON RND

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	163W00000X	Registered Nurse	RN60184769	WA

General Provider Information

NPI Number	:	1972382703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANDERSON RND

Provider Business Mailing Address
First Line	:	1161 E EAGLE POINT DR
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-6647
Country	:	US
Telephone Number	:	360-229-6402
Fax Number	:	360-229-6402

Provider Business Practice Location Address
First Line	:	1161 E EAGLE POINT DR
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-6647
Country	:	US
Telephone Number	:	360-229-6402
Fax Number	:

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

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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