Provider Demographics
NPI:1417993148
Name:BATES, JENNIFER A
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:5580 NORDIC WAY
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9138
Practice Address - Country:US
Practice Address - Phone:360-384-1511
Practice Address - Fax:360-384-5758
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4582BAOtherREGENCE BLUESHIELD
WA423898071OtherGROUP HEALTH COOPERATIVE
WA8252249Medicaid
WA0188849OtherLABOR & INDUSTRIES (REG)
WAP00181773OtherRAILROAD MEDICARE
WA8938884OtherLABOR & INDUSTRIES (CV)
WA423898071OtherGROUP HEALTH COOPERATIVE
WAH12217Medicare UPIN