Healthcare Provider Details

I. General information

NPI: 1053057968
Provider Name (Legal Business Name): NICOLE CHRISTINE JANSSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MADISON ST STE 100
SEATTLE WA
98104-1316
US

IV. Provider business mailing address

1401 MADISON ST STE 100
SEATTLE WA
98104-1316
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6111
  • Fax: 206-568-7043
Mailing address:
  • Phone: 206-320-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD70088635
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: