Basic Information
| Provider Information | |||||||||
| NPI: | 1114351848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTLEY-JONASON | ||||||||
| FirstName: | NIKKI | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARTLEY-JONASON | ||||||||
| OtherFirstName: | NIKKI | ||||||||
| OtherMiddleName: | LEE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX H | ||||||||
| Address2: | |||||||||
| City: | ILWACO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986240258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606426387 | ||||||||
| FaxNumber: | 3606420064 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 BAY AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | OCEAN PARK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986404203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606423747 | ||||||||
| FaxNumber: | 3606423361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP60669740 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.