Basic Information
| Provider Information | |||||||||
| NPI: | 1528492592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAIL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | EVELYN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20120 BALLINGER WAY NE SUITE B | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068585059 | ||||||||
| FaxNumber: | 9493859207 | ||||||||
| Practice Location | |||||||||
| Address1: | 13718 100TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980345216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258144888 | ||||||||
| FaxNumber: | 4258143788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2013 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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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 | 363A00000X | 5472 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA.60543660 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.