Provider Demographics
NPI:1053605600
Name:PENSE, JENNIFER N (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:N
Last Name:PENSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:SEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3908 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2188
Mailing Address - Country:US
Mailing Address - Phone:253-848-5951
Mailing Address - Fax:253-845-7073
Practice Address - Street 1:611 31ST AVE SW
Practice Address - Street 2:STE C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3723
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:253-845-7073
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60384424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8943976Medicare PIN