Basic Information
| Provider Information | |||||||||
| NPI: | 1154852366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IVERSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1845 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986681845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603978484 | ||||||||
| FaxNumber: | 3603978494 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 E FOURTH PLAIN BLVD | ||||||||
| Address2: | BUILDING 17, SUITE B222 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986613713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603978484 | ||||||||
| FaxNumber: | 3603978494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2017 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN60718655 | WA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.