Provider Demographics
NPI:1952075699
Name:REYES, JENIFER (FNP)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 S OTHELLO ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3510
Mailing Address - Country:US
Mailing Address - Phone:206-788-3500
Mailing Address - Fax:
Practice Address - Street 1:3815 S OTHELLO ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3510
Practice Address - Country:US
Practice Address - Phone:206-788-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60423229163WG0000X
WAAP61211268363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty