Provider Demographics
NPI:1740280056
Name:WINTER, JENNIFER E (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:WINTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W BAY DR NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4958
Mailing Address - Country:US
Mailing Address - Phone:360-413-8760
Mailing Address - Fax:360-413-8839
Practice Address - Street 1:304 W BAY DR NW
Practice Address - Street 2:SUITE 301
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4958
Practice Address - Country:US
Practice Address - Phone:360-413-8760
Practice Address - Fax:360-413-8839
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA100003762363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB20351OtherMEDICARE
WA8214603Medicaid
WA8214603Medicaid
WAS91670Medicare UPIN