Provider Demographics
NPI:1205559291
Name:SPREADBOROUGH, JEANETTE R (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:R
Last Name:SPREADBOROUGH
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 GARDEN SPOT RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99110
Mailing Address - Country:US
Mailing Address - Phone:360-957-2167
Mailing Address - Fax:
Practice Address - Street 1:1020 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1055
Practice Address - Country:US
Practice Address - Phone:360-533-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61392390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily