Provider Demographics
NPI:1578745048
Name:PRIMEAU, JENNIFER NICOLE (LMP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:PRIMEAU
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 NW 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117
Mailing Address - Country:US
Mailing Address - Phone:425-417-6403
Mailing Address - Fax:
Practice Address - Street 1:1138 NW MARKET ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3710
Practice Address - Country:US
Practice Address - Phone:425-417-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist