Individual
JENNIFER WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
200 NE MOTHER JOSEPH PL STE 300, VANCOUVER, WA 98664
(360) 254-6161
(360) 449-1146
Mailing address
200 NE MOTHER JOSEPH PL STE 210, VANCOUVER, WA 98664-3295
(360) 254-6161
(360) 449-1146
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
00157320
WA
163W00000X
Registered Nurse
200240758RN
OR
363LF0000X
Family Nurse Practitioner
200950128NP
OR
363LF0000X
Family Nurse Practitioner
Primary
AP60107358
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0255099
LABOR & INDUSTRIES
WA
05
—
9662735
—
WA
Enumeration date
07/22/2008
Last updated
08/07/2018
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