Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP30006120 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP30006120 | WA |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP30006120 | WA |
NPI | 1891775664 |
---|---|
Provider Name | Jean M Wessel |
First Address | Darrington, WA 98241-9420 |
Second Address | Darrington, WA 98241-9420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9512KE | REGENCE BLUESHIELD (01) | WA |
9645573 | (05) | WA |
P61776 | (02) | WA |