Provider Demographics
NPI:1417838756
Name:PENA, JENNIFER L (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:PENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23912 113TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5309
Mailing Address - Country:US
Mailing Address - Phone:206-214-6552
Mailing Address - Fax:
Practice Address - Street 1:1801 LIND AVE SW BLDG D
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3368
Practice Address - Country:US
Practice Address - Phone:425-227-3700
Practice Address - Fax:425-227-3116
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60582711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse