Provider Demographics
NPI:1699319483
Name:PEDERSEN, JANA (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N MULLAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VLY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4046
Mailing Address - Country:US
Mailing Address - Phone:509-251-2087
Mailing Address - Fax:
Practice Address - Street 1:1410 N MULLAN RD STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4046
Practice Address - Country:US
Practice Address - Phone:509-838-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60998181363L00000X
ID59364363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty