Provider Demographics
NPI:1053918730
Name:BASTINE, JESSICA LYNN (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BASTINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0626
Mailing Address - Country:US
Mailing Address - Phone:509-701-9650
Mailing Address - Fax:509-878-4078
Practice Address - Street 1:411 S EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0626
Practice Address - Country:US
Practice Address - Phone:509-701-9650
Practice Address - Fax:509-878-4078
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60730152163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse