Jewelene Rae Pattullo

Primary specialty

OpticianTaxonomy code 156FX1800X

License

DO00001723 Issued in WA

Practice address

14406 NE 20TH Ave
Vancouver, WA 98686-1448

Phone

(360) 418-6001

NPI assigned

Aug 24, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Jewelene Rae Henline Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760599609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 NE 52ND CIR",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617805",
            "telephone_number": "360-695-4912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14406 NE 20TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986861448",
            "telephone_number": "360-418-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTULLO",
        "first_name": "JEWELENE",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "WA",
            "license": "DO00001723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEWELENE",
            "last_name": "HENLINE",
            "middle_name": "RAE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tammy Patterson, RN, BSN
• Tiffany Patterson, OTR/L
• Adrienne Grace Pattison
• Danya M Patton, CDP
• Susanna Dorothy Patton, BS
• Kusum Paudel, MD
• Elizabeth Anne Paul, RN
• Karina Alexandrovna Paul, FNP-C
• Melissa Anne Paul, MSN, FNP-C
• Michelle Raeann Paul, DOULA

• Optician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Optician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.