Provider Demographics
NPI:1649426354
Name:JARNES, GAYLENE ELLIN (LMP)
Entity type:Individual
Prefix:
First Name:GAYLENE
Middle Name:ELLIN
Last Name:JARNES
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 1:4307 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1936
Mailing Address - Country:US
Mailing Address - Phone:425-747-5657
Mailing Address - Fax:425-747-5334
Practice Address - Street 1:4307 FACTORIA BLVD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1936
Practice Address - Country:US
Practice Address - Phone:425-747-5657
Practice Address - Fax:425-747-5334
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60004256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist