Provider Demographics
NPI:1215689872
Name:WILEY, JESSICA (BSN, RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 N 198TH ST UNIT C304
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3661
Mailing Address - Country:US
Mailing Address - Phone:206-429-5281
Mailing Address - Fax:
Practice Address - Street 1:1132 N 198TH ST UNIT C304
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3661
Practice Address - Country:US
Practice Address - Phone:206-429-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60673694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty