Provider Demographics
NPI:1922023209
Name:TOLO, JENNIFER CROWE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CROWE
Last Name:TOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JANE
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1603 116TH AVE NE
Mailing Address - Street 2:STE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3009
Mailing Address - Country:US
Mailing Address - Phone:425-898-8517
Mailing Address - Fax:
Practice Address - Street 1:1603 116TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3009
Practice Address - Country:US
Practice Address - Phone:425-458-4895
Practice Address - Fax:425-458-4895
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00034260OtherSTATE LICENSE
WA1119221Medicaid
WA1119221Medicaid
G48892Medicare UPIN
WA1119221Medicaid