Provider Demographics
NPI:1871051730
Name:JANOWIECKI, JENNIFFER (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:
Last Name:JANOWIECKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15790 REDMOND WAY # 1106
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3830
Mailing Address - Country:US
Mailing Address - Phone:813-336-1840
Mailing Address - Fax:
Practice Address - Street 1:15790 REDMOND WAY # 1106
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3830
Practice Address - Country:US
Practice Address - Phone:813-336-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61105524363LP0808X
AL1-171615163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health