Healthcare Provider Details

I. General information

NPI: 1023732583
Provider Name (Legal Business Name): JANIN ANN KHALEEL FNP, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 31ST AVE W
SEATTLE WA
98199-3335
US

IV. Provider business mailing address

401 5TH AVE
SEATTLE WA
98104-1818
US

V. Phone/Fax

Practice location:
  • Phone: 509-528-0037
  • Fax:
Mailing address:
  • Phone: 206-296-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61355224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: