Provider Demographics
NPI:1891775664
Name:WESSEL, JEAN M (ARNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:WESSEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 CHIEF BROWN LN
Mailing Address - Street 2:
Mailing Address - City:DARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98241-9420
Mailing Address - Country:US
Mailing Address - Phone:360-436-2210
Mailing Address - Fax:360-436-2226
Practice Address - Street 1:5318 CHIEF BROWN LN
Practice Address - Street 2:
Practice Address - City:DARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:98241-9420
Practice Address - Country:US
Practice Address - Phone:360-436-2210
Practice Address - Fax:360-436-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00046951163WC0400X, 163WG0000X
WAAP30006120363LC1500X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9512KEOtherREGENCE BLUESHIELD
WA9645573Medicaid
WAP61776Medicare UPIN
WA8EZ88HMedicare PIN