Individual
JESSICA T WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
6060 PORTAL WAY, FERNDALE, WA 98248-7833
(360) 676-6177
(360) 671-3574
Mailing address
1616 CORNWALL AVE STE 205, BELLINGHAM, WA 98225-4642
(360) 676-6177
(360) 527-8778
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00163760
WA
363LF0000X
Family Nurse Practitioner
Primary
AP60054777
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9658832
—
WA
01
—
G8876610
MEDICARE PTAN
WA
Enumeration date
07/22/2008
Last updated
04/20/2023
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