Healthcare Provider Details

I. General information

NPI: 1386789634
Provider Name (Legal Business Name): JANE MAYER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25959 COMMUNITY PLAZA WAY
SEDRO WOOLLEY WA
98284-9721
US

IV. Provider business mailing address

25944 COMMUNITY PLAZA WAY
SEDRO WOOLLEY WA
98284-9721
US

V. Phone/Fax

Practice location:
  • Phone: 360-854-7069
  • Fax:
Mailing address:
  • Phone: 360-854-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP30000228
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: