Provider Demographics
NPI:1184096562
Name:BALE, JENNIFER TALANA GIBBS (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TALANA GIBBS
Last Name:BALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:TALANA
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 S HORTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6917
Mailing Address - Country:US
Mailing Address - Phone:206-252-7407
Mailing Address - Fax:206-743-3151
Practice Address - Street 1:3301 S HORTON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6917
Practice Address - Country:US
Practice Address - Phone:206-252-7407
Practice Address - Fax:206-743-3151
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60271413163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool