Provider Demographics
NPI:1750405767
Name:KAUFMAN, JENNIFER ALTMILLER (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALTMILLER
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2010
Mailing Address - Country:US
Mailing Address - Phone:509-758-2200
Mailing Address - Fax:509-758-6511
Practice Address - Street 1:625 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2010
Practice Address - Country:US
Practice Address - Phone:509-758-2200
Practice Address - Fax:509-758-6511
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 829A363L00000X
WAAP60456289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60456289OtherWA ARNP
IDN-34430OtherRN LICENSE