Provider Demographics
NPI:1386789634
Name:MAYER, JANE (ARNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25944 COMMUNITY PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9721
Mailing Address - Country:US
Mailing Address - Phone:360-854-7069
Mailing Address - Fax:
Practice Address - Street 1:25959 COMMUNITY PLAZA WAY
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9721
Practice Address - Country:US
Practice Address - Phone:360-854-7069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000228364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9033MAOtherREGENCE BLUE SHIELD
WA9600081Medicaid
WA9600081Medicaid