Provider Demographics
NPI:1073005393
Name:JIRU, JENNIFER BROOKE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:JIRU
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:STE 1440
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3538
Mailing Address - Country:US
Mailing Address - Phone:805-657-2883
Mailing Address - Fax:
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:STE 1440
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3538
Practice Address - Country:US
Practice Address - Phone:805-657-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60570129163WC0200X
WAAP60905090367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Multi-Specialty