Provider Demographics
NPI:1538225701
Name:THURSTON, JEFFREY W (ARNP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:THURSTON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 75TH ST W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8368
Mailing Address - Country:US
Mailing Address - Phone:253-983-1539
Mailing Address - Fax:253-588-2693
Practice Address - Street 1:6212 75TH ST W
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8368
Practice Address - Country:US
Practice Address - Phone:253-983-1539
Practice Address - Fax:253-588-2693
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00085153OtherREGISTERED NURSE LICENSE
WAAP30002150OtherARNP LICENSE