Provider Demographics
NPI:1184306342
Name:WHALEN, JAYMI
Entity type:Individual
Prefix:
First Name:JAYMI
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13413 NE LEROY HAGEN MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5967
Mailing Address - Country:US
Mailing Address - Phone:360-604-6850
Mailing Address - Fax:
Practice Address - Street 1:13413 NE LEROY HAGEN MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5967
Practice Address - Country:US
Practice Address - Phone:360-604-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00156190163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool