1689733412 NPI number — JANET E TIVEL ARNP

Table of content: JANET E TIVEL ARNP (NPI 1689733412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689733412 NPI number — JANET E TIVEL ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIVEL
Provider First Name:
JANET
Provider Middle Name:
E
Provider Name Prefix Text:
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:
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:
1689733412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19695 LANDING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98273-8198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-421-7427
Provider Business Mailing Address Fax Number:
360-299-8605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 SEAFARERS WAY
Provider Second Line Business Practice Location Address:
STE 201B
Provider Business Practice Location Address City Name:
ANACORTES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98221-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-588-1460
Provider Business Practice Location Address Fax Number:
360-588-1473
Provider Enumeration Date:
12/07/2006

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: 363L00000X , with the licence number:  AP30001131 , 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: 9600032 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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