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General NPI Number Information
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NPI Number | 1841902210
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Entity Type | Individual
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Provider Name | JANAE K NELSON
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 1450 5TH ST SE STE 1200
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City | PUYALLUP
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State | WA
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Zip | 98372-4688
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Country | US
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Telephone | 253-697-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 8315 PHILLIPS RD SW
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City | LAKEWOOD
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State | WA
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Zip | 98498-6349
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Country | US
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Telephone | 206-658-7115
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61229521
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License Number State | WA
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