Provider Demographics
NPI:1497080139
Name:MARTINSON, JENNIFER LANGE (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LANGE
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:COLLEEN
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY,
Mailing Address - Street 2:SUITE 1607 QLIANCE MEDICAL GROUP OF WASHINGTON PC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-913-4700
Mailing Address - Fax:206-913-4710
Practice Address - Street 1:509 OLIVE WAY,
Practice Address - Street 2:SUITE 1607 QLIANCE MEDICAL GROUP OF WASHINGTON PC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-913-4700
Practice Address - Fax:206-913-4710
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60075685363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner