Provider Demographics
NPI:1205405099
Name:CHRISTOPHERSON, JESSICA ASHLEY (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ASHLEY
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:SALKUM
Mailing Address - State:WA
Mailing Address - Zip Code:98582-0351
Mailing Address - Country:US
Mailing Address - Phone:480-570-9070
Mailing Address - Fax:
Practice Address - Street 1:125 REBEL LANE
Practice Address - Street 2:
Practice Address - City:SALKUM
Practice Address - State:WA
Practice Address - Zip Code:98582
Practice Address - Country:US
Practice Address - Phone:480-570-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60201784163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice