Provider Demographics
NPI:1568894608
Name:MCCASLIN, JENNIFER KATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATHERINE
Last Name:MCCASLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 38TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4801
Mailing Address - Country:US
Mailing Address - Phone:425-319-5900
Mailing Address - Fax:
Practice Address - Street 1:13820 19TH AVE NE
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6706
Practice Address - Country:US
Practice Address - Phone:425-319-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60264230163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA163WHOOOOOXMedicaid