Provider Demographics
NPI:1447787502
Name:SANGENITO, JEAN MARIE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:SANGENITO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 NW 3RD WAY
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4247
Mailing Address - Country:US
Mailing Address - Phone:360-991-2709
Mailing Address - Fax:
Practice Address - Street 1:2418 NW 3RD WAY
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4247
Practice Address - Country:US
Practice Address - Phone:360-991-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60327907163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse