Provider Demographics
NPI:1073311288
Name:PEDEFERRI, JAIME (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:PEDEFERRI
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 199TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-9025
Mailing Address - Country:US
Mailing Address - Phone:425-466-8089
Mailing Address - Fax:
Practice Address - Street 1:2411 199TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:LAKE TAPPS
Practice Address - State:WA
Practice Address - Zip Code:98391-9025
Practice Address - Country:US
Practice Address - Phone:425-466-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00161150363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health