Provider Demographics
NPI:1407349871
Name:CARLSON, JENNIFER A (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:WANKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:816 W FRANCIS AVE # 502
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6512
Mailing Address - Country:US
Mailing Address - Phone:509-581-3550
Mailing Address - Fax:509-232-3309
Practice Address - Street 1:5920 N BRIDGET ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7062
Practice Address - Country:US
Practice Address - Phone:509-581-3550
Practice Address - Fax:509-232-3309
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAARNP.AP.60860636-NP207Q00000X, 208VP0014X
WAAP60860636363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2145049Medicaid