Provider Demographics
NPI:1750433223
Name:JAYE, LAUREN B (CNM)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:JAYE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4503
Mailing Address - Country:US
Mailing Address - Phone:360-420-7413
Mailing Address - Fax:888-890-1130
Practice Address - Street 1:941 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-4717
Practice Address - Country:US
Practice Address - Phone:360-420-7413
Practice Address - Fax:888-890-1130
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001875363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9603366Medicaid
WA266646OtherLABOR & INDUSTRIES
WA1750433223Medicaid
WA9603366Medicaid