1659313476 NPI number — JANICE STRACENER MD

Table of content: JANICE STRACENER MD (NPI 1659313476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659313476 NPI number — JANICE STRACENER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRACENER
Provider First Name:
JANICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659313476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-292-6233
Provider Business Mailing Address Fax Number:
206-292-7764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1229 MADISON ST
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-3586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-292-6233
Provider Business Practice Location Address Fax Number:
206-292-7764
Provider Enumeration Date:
06/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD00028973 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8252322 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".