1437431947 NPI number — JESSICA M ROWAN CNM, ARNP

Table of content: ANDREW RANDALL DPT (NPI 1497278667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437431947 NPI number — JESSICA M ROWAN CNM, ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROWAN
Provider First Name:
JESSICA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM, ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437431947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1812 S J ST
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-4964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-207-4890
Provider Business Mailing Address Fax Number:
253-207-4871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1812 S J ST
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-4964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-207-4890
Provider Business Practice Location Address Fax Number:
253-207-4871
Provider Enumeration Date:
09/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN00169958 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: AP60235010 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0285744 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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