Provider Demographics
NPI:1811979396
Name:NOLAN-MONTELEONE, JENNIFER ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:NOLAN-MONTELEONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12910 TOTEM LAKE BLVD NE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2954
Mailing Address - Country:US
Mailing Address - Phone:425-899-3270
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:22010 17TH AVE SE
Practice Address - Street 2:SUITE F
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8486
Practice Address - Country:US
Practice Address - Phone:425-488-4988
Practice Address - Fax:425-488-4993
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA201827OtherLABOR & INDUSTRIES
WA8339368Medicaid
WA8856659Medicare ID - Type Unspecified
WA8339368Medicaid