Provider Demographics
NPI:1194125716
Name:STEFFAN, JENNIFER ROSE (RN, ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:STEFFAN
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-474-2544
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:62 W 7TH AVE STE 450
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2321
Practice Address - Country:US
Practice Address - Phone:509-455-8820
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60375631163W00000X
WAAP60512126363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1194125716OtherL&I
WA1194125716Medicaid
WA1194125716Medicaid