Healthcare Provider Details

I. General information

NPI: 1568848406
Provider Name (Legal Business Name): CARL JANZ R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR 9040 REID ST, ATTN: MCHJ-CLQ-C
TACOMA WA
98431-1100
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CTR 9040 REID ST, ATTN: MCHJ-CLQ-C
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3059
  • Fax:
Mailing address:
  • Phone: 253-968-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number0178155
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN60683138
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: