Provider Demographics
NPI:1720207129
Name:BEARDSLEY, JAMIE LYNN (RN)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LYNN
Last Name:BEARDSLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W OWENS RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9321
Mailing Address - Country:US
Mailing Address - Phone:206-409-8310
Mailing Address - Fax:509-297-7903
Practice Address - Street 1:303 W OWENS RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-9321
Practice Address - Country:US
Practice Address - Phone:206-409-8310
Practice Address - Fax:509-297-7903
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016719225700000X
WARN60573882163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0166498OtherLABOR AND INDUSTRY