Provider Demographics
NPI:1437156114
Name:NORDSTROM-ZUARES, JENNIFER JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:NORDSTROM-ZUARES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1221 MADISON ST STE 1220
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1356
Practice Address - Country:US
Practice Address - Phone:206-215-4250
Practice Address - Fax:206-215-4252
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60111601363AM0700X, 363A00000X
NVPA1048363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACD8128OtherGROUP RR #
NV100512418Medicaid
WAPA60111601OtherWA LICENSE
WA8554693Medicaid
WACD8128OtherGROUP RR #
NV100512418Medicaid
NV104071Medicare PIN
WAG8851596Medicare PIN
WA000188100Medicare PIN
WAG8851595Medicare PIN
WAG8884984Medicare PIN
WA8554693Medicaid
WAG8884983Medicare PIN
WAG8851594Medicare PIN
WAG8880511Medicare PIN
WAAB13179Medicare PIN