Individual
CARRIE L JENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7210 40TH ST W, STE 100, UNIVERSITY PLACE, WA 98466-4237
(253) 564-0170
(253) 207-4240
Mailing address
7210 40TH ST W, STE 100, UNIVERSITY PLACE, WA 98466-4237
(253) 564-0170
(253) 207-4240
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00034173
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126537
L & I
WA
01
—
370013713
RAILROAD
WA
05
—
8208399
—
WA
01
—
8935092
CRIME VICTIMS
WA
Enumeration date
08/10/2006
Last updated
11/23/2010
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