Provider Demographics
NPI:1114351848
Name:HARTLEY-JONASON, NIKKI LEE (FNP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEE
Last Name:HARTLEY-JONASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:NIKKI
Other - Middle Name:LEE
Other - Last Name:HARTLEY-JONASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0258
Mailing Address - Country:US
Mailing Address - Phone:360-642-6387
Mailing Address - Fax:360-642-0064
Practice Address - Street 1:1501 BAY AVE STE 201
Practice Address - Street 2:
Practice Address - City:OCEAN PARK
Practice Address - State:WA
Practice Address - Zip Code:98640-4203
Practice Address - Country:US
Practice Address - Phone:360-642-3747
Practice Address - Fax:360-642-3361
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60669740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA503988Medicare Oscar/Certification