Provider Demographics
NPI:1710068598
Name:JAQUES, SHARI SYRDAL (ARNP MN)
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:SYRDAL
Last Name:JAQUES
Suffix:
Gender:F
Credentials:ARNP MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 292
Mailing Address - Street 2:1306 LAKEVIEW DRIVE
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0292
Mailing Address - Country:US
Mailing Address - Phone:360-568-8737
Mailing Address - Fax:360-568-1654
Practice Address - Street 1:17440 BROOKSIDE BLVD NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155
Practice Address - Country:US
Practice Address - Phone:206-366-9384
Practice Address - Fax:206-364-0076
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00044602163W00000X
WAAP30004096363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB08010Medicare ID - Type Unspecified
AB05000Medicare ID - Type UnspecifiedGROUP