Provider Demographics
NPI:1265846745
Name:MARKS, JESSIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:KLAUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1940 116TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3074
Mailing Address - Country:US
Mailing Address - Phone:425-298-6679
Mailing Address - Fax:068-991-2992
Practice Address - Street 1:4545 CORDATA PKWY STE 1E
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7264
Practice Address - Country:US
Practice Address - Phone:360-752-5246
Practice Address - Fax:360-752-5678
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60495839363LP0200X
WARN60222054363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8933896Medicare PIN