Provider Demographics
NPI:1881858611
Name:NOELKE, JENNIFER L (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:NOELKE
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16045 1ST AVE S FL 2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1401
Mailing Address - Country:US
Mailing Address - Phone:206-965-4200
Mailing Address - Fax:206-965-4279
Practice Address - Street 1:16045 1ST AVE S FL 2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1401
Practice Address - Country:US
Practice Address - Phone:206-965-4200
Practice Address - Fax:206-965-4279
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60920821367A00000X
WARN60766084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2254695Medicaid