MEDICARE: JANICE LYNN NELSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00128282	WA

General Provider Information

NPI Number	:	1679139976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE LYNN NELSON RN

Provider Business Mailing Address
First Line	:	8833 29TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3708
Country	:	US
Telephone Number	:	206-914-4201
Fax Number	:

Provider Business Practice Location Address
First Line	:	8833 29TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3708
Country	:	US
Telephone Number	:	206-914-4201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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