Provider Demographics
NPI:1972238681
Name:WALTS DONAHUE, JASMINE SARED (CPC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:SARED
Last Name:WALTS DONAHUE
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-0121
Mailing Address - Country:US
Mailing Address - Phone:360-540-5104
Mailing Address - Fax:
Practice Address - Street 1:20509 JIM CREEK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6873
Practice Address - Country:US
Practice Address - Phone:360-540-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist