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General NPI Number Information
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NPI Number | 1306051867
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Entity Type | Individual
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Provider Name | JANET LYNN BLACK ARNP, RN
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 273 SUSSEX AVE E
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City | TENINO
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State | WA
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Zip | 98589-9359
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Country | US
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Telephone | 360-264-5665
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Fax | 360-264-5666
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Provider Business Mailing Address
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Address Line | 5040 STATE HIGHWAY 507 SE
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City | TENINO
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State | WA
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Zip | 98589-9661
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Country | US
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Telephone | 360-264-5665
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Fax | 360-264-5666
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP30004239
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License Number State | WA
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