Provider Demographics
NPI:1528362845
Name:MICHELET, JENNY BENDECK (PA)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:BENDECK
Last Name:MICHELET
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 N 5TH AVE
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3045
Mailing Address - Country:US
Mailing Address - Phone:360-582-2690
Mailing Address - Fax:360-582-2691
Practice Address - Street 1:800 N 5TH AVE
Practice Address - Street 2:SUITE # 101
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-582-2690
Practice Address - Fax:360-582-2691
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATA 60198787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical