Provider Demographics
NPI:1255595062
Name:JESSEN, BARBARA GREEN (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:GREEN
Last Name:JESSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 SW SHOREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3068
Mailing Address - Country:US
Mailing Address - Phone:206-242-0201
Mailing Address - Fax:206-242-3068
Practice Address - Street 1:1847 SW SHOREVIEW LN
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-3068
Practice Address - Country:US
Practice Address - Phone:206-242-0201
Practice Address - Fax:206-242-3068
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000261042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology