Provider Demographics
NPI:1740416460
Name:GEORGE, JENNIFER ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MCNITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4912 110TH AVENUE CT E
Mailing Address - Street 2:APT #2
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372-2271
Mailing Address - Country:US
Mailing Address - Phone:425-301-7378
Mailing Address - Fax:
Practice Address - Street 1:4912 110TH AVENUE CT E
Practice Address - Street 2:APT #2
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98372-2271
Practice Address - Country:US
Practice Address - Phone:425-301-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00024030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist