Provider Demographics
NPI:1295136778
Name:CABARRUS, JENNIFER (LMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CABARRUS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 131ST ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7105
Mailing Address - Country:US
Mailing Address - Phone:206-841-8210
Mailing Address - Fax:
Practice Address - Street 1:15118 MAIN ST
Practice Address - Street 2:#500
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1653
Practice Address - Country:US
Practice Address - Phone:425-337-7029
Practice Address - Fax:888-397-1514
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60503896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist