Provider Demographics
NPI:1821311465
Name:KRATZER, JENNIFER KOLEKA (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KOLEKA
Last Name:KRATZER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 214
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-985-2920
Mailing Address - Fax:253-382-8545
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 214
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-985-2920
Practice Address - Fax:253-382-8545
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001359367A00000X
WAAP60410244367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2037221Medicaid