Provider Demographics
NPI:1558470393
Name:WHETZEL, JANE A (ARNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:WHETZEL
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 1:4341 SPRINGDALE HUNTERS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:WA
Mailing Address - Zip Code:99173-9713
Mailing Address - Country:US
Mailing Address - Phone:509-258-9624
Mailing Address - Fax:
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:SUITE 518
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2823
Practice Address - Country:US
Practice Address - Phone:509-747-3147
Practice Address - Fax:509-747-0020
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA142619OtherL&I
WA8322489Medicaid
WAP 38471Medicare UPIN
WA142619OtherL&I