Provider Demographics
NPI:1790856136
Name:SCHAUER, JENNIFER E (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SCHAUER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:VESEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3903
Mailing Address - Fax:
Practice Address - Street 1:15418 MAIN ST
Practice Address - Street 2:SUITE M303
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9030
Practice Address - Country:US
Practice Address - Phone:425-225-8003
Practice Address - Fax:425-225-8027
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006948363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
8868876Medicare PIN
WA9645282Medicare UPIN