Provider Demographics
NPI:1861857336
Name:RUBIO, JENNIFER (DNP, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:RUBIO
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, ARNP
Mailing Address - Street 1:10310 GRAVELLY LAKE DR SW STE B
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-5014
Mailing Address - Country:US
Mailing Address - Phone:253-888-3405
Mailing Address - Fax:
Practice Address - Street 1:10310 GRAVELLY LAKE DR SW STE B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-888-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60017401163W00000X
WAAP60647417363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse