Provider Demographics
NPI:1528122447
Name:JONES, TRUDY (MN, ARNP)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:WA
Mailing Address - Zip Code:98342-0037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359777
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-731-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001773363LF0000X
WAAP300001773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9610890Medicaid
WAS63249Medicare UPIN