Provider Demographics
NPI:1043023401
Name:OKUMURA, JILLIAN DIANE (RN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:DIANE
Last Name:OKUMURA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:DIANE
Other - Last Name:ANTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3714 19TH AVENUE CT SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4232
Mailing Address - Country:US
Mailing Address - Phone:808-756-2108
Mailing Address - Fax:
Practice Address - Street 1:3714 19TH AVENUE CT SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4232
Practice Address - Country:US
Practice Address - Phone:808-756-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60606094163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse