Provider Demographics
NPI:1366795585
Name:NIRSCHL, JENIFER J
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:J
Last Name:NIRSCHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 BEAVER BLVD
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047-1375
Mailing Address - Country:US
Mailing Address - Phone:253-332-2279
Mailing Address - Fax:
Practice Address - Street 1:820 HARVEY RD STE A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4247
Practice Address - Country:US
Practice Address - Phone:253-332-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA 60253856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist