Provider Demographics
NPI:1275752198
Name:EDMINSTER, JENNIFER LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:EDMINSTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 N LIDGERWOOD ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5095
Mailing Address - Country:US
Mailing Address - Phone:509-483-4161
Mailing Address - Fax:509-483-0329
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:SUITE 217
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5095
Practice Address - Country:US
Practice Address - Phone:509-483-4161
Practice Address - Fax:509-483-0329
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005982363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9641648Medicaid