Active NPI
Renee Jackson
- Registered Nurse
- Lacey, WA
National Provider Identifier
1376963280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN00108453
- Practice address
- 305 College St NE
Lacey, WA 98516-5390 - Phone
- (360) 412-4466
- NPI assigned
- Apr 17, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN00108453 | WA | Primary |
Addresses
Primary practice location
305 College St NE
Lacey, WA 98516-5390
Mailing address
305 College St NE
Lacey, WA 98516-5390
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN00108453 | WA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397692800000",
"number": "1376963280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 COLLEGE ST NE",
"city": "LACEY",
"state": "WA",
"postal_code": "985165390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 COLLEGE ST NE",
"city": "LACEY",
"state": "WA",
"postal_code": "985165390",
"telephone_number": "360-412-4466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-17",
"last_updated": "2014-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN00108453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.