Provider Demographics
NPI:1598749590
Name:KAISER, JAENIFFER ANG (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JAENIFFER
Middle Name:ANG
Last Name:KAISER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JAENIFFER
Other - Middle Name:GUINO-O
Other - Last Name:CHAMBERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1515 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1846
Mailing Address - Country:US
Mailing Address - Phone:509-488-5256
Mailing Address - Fax:509-488-9939
Practice Address - Street 1:1051 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326-8702
Practice Address - Country:US
Practice Address - Phone:509-488-5256
Practice Address - Fax:509-488-9939
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1038391Medicaid
WAAP30004437OtherWASHINGTON STATE DEPT. OF HEALTH