Provider Demographics
NPI:1760579759
Name:JONES-VANDERLEEST, JENNIFER GWYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GWYNNE
Last Name:JONES-VANDERLEEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GWYNNE
Other - Last Name:VANDERLEEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:JAIL HEALTH SERVICES DIVISION, PUBLIC HEALTH-SEATTLE &
Mailing Address - Street 2:500 5TH AVE, 6W
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-477-6310
Mailing Address - Fax:206-296-1771
Practice Address - Street 1:JAIL HEALTH SERVICES DIVISION, PUBLIC HEALTH-SEATTLE &
Practice Address - Street 2:500 5TH AVE, 6W
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-477-6310
Practice Address - Fax:206-296-1771
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60109824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60109824OtherLICENSE
WAMD60109824OtherLICENSE
90668Medicare UPIN