Provider Demographics
NPI:1184182008
Name:JENMARK
Entity Type:Organization
Organization Name:JENMARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-832-7078
Mailing Address - Street 1:10991 ECHO ROCK PL
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5111
Mailing Address - Country:US
Mailing Address - Phone:206-832-7078
Mailing Address - Fax:
Practice Address - Street 1:805 FRONT ST S
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-4205
Practice Address - Country:US
Practice Address - Phone:425-392-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty