Provider Demographics
NPI:1720044373
Name:PURCELL, JENNIFER LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:PURCELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W RAINIER WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6021
Mailing Address - Country:US
Mailing Address - Phone:509-710-7975
Mailing Address - Fax:
Practice Address - Street 1:2709 W BOONE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3001
Practice Address - Country:US
Practice Address - Phone:509-325-0393
Practice Address - Fax:509-325-7209
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9632555Medicaid
WAMP0759398OtherDEA
WAMP0759398OtherDEA
WA8801805Medicare ID - Type Unspecified