Provider Demographics
NPI:1275360711
Name:SMITH, JENNIFER M (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 6TH AVE SE STE 201
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1042
Mailing Address - Country:US
Mailing Address - Phone:360-459-8311
Mailing Address - Fax:
Practice Address - Street 1:4412 182ND LN SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-9440
Practice Address - Country:US
Practice Address - Phone:360-480-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60722853163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health