1194817700 NPI number — MS. JANET MARIE NESS ARNP

Table of content: PAIGE MAHER PA-C (NPI 1104376912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194817700 NPI number — MS. JANET MARIE NESS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NESS
Provider First Name:
JANET
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RANDA
Provider Other First Name:
JANET
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194817700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 WAINWRIGHT DR.
Provider Second Line Business Mailing Address:
JONATHAN M. WAINWRIGHT MEDICAL CENTER
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-525-5200
Provider Business Mailing Address Fax Number:
907-260-3697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 FRUITVALE BLVD
Provider Second Line Business Practice Location Address:
YAKIMA COMMUNITY BASED OUTPT. CLINIC (CBOC)
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-0199
Provider Business Practice Location Address Fax Number:
509-966-4266
Provider Enumeration Date:
09/29/2006

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: 363LP0808X , with the licence number:  737 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP60095267 , 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: RH177FQ , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: MH0156 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".