Provider Demographics
NPI:1801311865
Name:BULLER NOFZIGER, JENNA M (ARNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:BULLER NOFZIGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:BULLER NOFZIGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:4313 S WEBSTER ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4156
Mailing Address - Country:US
Mailing Address - Phone:419-306-6707
Mailing Address - Fax:
Practice Address - Street 1:3815 S OTHELLO ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3510
Practice Address - Country:US
Practice Address - Phone:206-788-3500
Practice Address - Fax:206-788-3521
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60392632163W00000X
WAAP60781225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse