Provider Demographics
NPI:1639584022
Name:DEGREE, JARRED GREGORY
Entity Type:Individual
Prefix:
First Name:JARRED
Middle Name:GREGORY
Last Name:DEGREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 N 9TH WAY
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-5449
Mailing Address - Country:US
Mailing Address - Phone:360-624-4778
Mailing Address - Fax:
Practice Address - Street 1:1210 N 9TH WAY
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-5449
Practice Address - Country:US
Practice Address - Phone:360-624-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide