Individual
JENNIFER TATE OPFERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1718 E KESSLER BLVD, LONGVIEW, WA 98632-1842
(360) 747-5800
(360) 575-3846
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 747-5800
(360) 575-3846
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10005022
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0212503
LABOR & IND. WA STATE
WA
05
—
8461782
—
WA
01
—
8942375
CRIME VICTIMS WA STATE
WA
01
—
P00341341
RR MEDICARE
—
Enumeration date
08/08/2006
Last updated
03/27/2013
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