Provider Demographics
NPI:1396831525
Name:NYMAN, JEANETTE ELS (ARNP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ELS
Last Name:NYMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18730 33RD AVE W
Mailing Address - Street 2:STE 100
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4756
Mailing Address - Country:US
Mailing Address - Phone:425-337-5100
Mailing Address - Fax:425-745-3933
Practice Address - Street 1:18730 33RD AVE W
Practice Address - Street 2:STE 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4756
Practice Address - Country:US
Practice Address - Phone:425-337-5100
Practice Address - Fax:425-745-3933
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003917261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center