Healthcare Provider Details

I. General information

NPI: 1245268721
Provider Name (Legal Business Name): JANNA MICHELLE HALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 NE 127TH ST
SEATTLE WA
98125-4415
US

IV. Provider business mailing address

2527 MADISON ST #7
EVERETT WA
98203-4893
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-7572
  • Fax: 206-361-6213
Mailing address:
  • Phone: 425-737-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00040023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: