Provider Demographics
NPI:1578545075
Name:HEUBERGER, JENNIFER L D (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L D
Last Name:HEUBERGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:DULANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1200-112TH AVE NE
Mailing Address - Street 2:STE C 115
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-455-0244
Mailing Address - Fax:425-455-9411
Practice Address - Street 1:1200-112TH AVE NE
Practice Address - Street 2:STE C 115
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-455-0244
Practice Address - Fax:425-455-9411
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily