Provider Demographics
NPI:1629374087
Name:JENNE, CELENA (RN, LMP)
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:
Last Name:JENNE
Suffix:
Gender:F
Credentials:RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32318 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5920
Mailing Address - Country:US
Mailing Address - Phone:253-202-3595
Mailing Address - Fax:
Practice Address - Street 1:32318 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5920
Practice Address - Country:US
Practice Address - Phone:253-202-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist