Provider Demographics
NPI:1831787118
Name:THIGPEN, JENNINE S (RN)
Entity type:Individual
Prefix:
First Name:JENNINE
Middle Name:S
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10714 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3734
Mailing Address - Country:US
Mailing Address - Phone:205-412-3520
Mailing Address - Fax:
Practice Address - Street 1:19507 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5236
Practice Address - Country:US
Practice Address - Phone:424-640-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60196180163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60196180OtherWA STATE DEPT OF HEALTH