Healthcare Provider Details

I. General information

NPI: 1265614689
Provider Name (Legal Business Name): JANE O'CONNOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 35TH AVE SW
SEATTLE WA
98126-3002
US

IV. Provider business mailing address

905 SPRUCE ST STE. 300
SEATTLE WA
98104-2474
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-6950
  • Fax: 206-461-8542
Mailing address:
  • Phone: 206-461-6935
  • Fax: 206-461-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00151211
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30007908
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: