Provider Demographics
NPI:1699700252
Name:JANCI, MARY M (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:JANCI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-353-3901
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:105 W 8TH AVE STE 7010
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2312
Practice Address - Country:US
Practice Address - Phone:509-353-3901
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00067944163W00000X
WAAP30005466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA71694UOtherREGENCE BLUESHIELD
WA9628397Medicaid
WA0142268OtherLABOR & INDUSTRY
WA9628397Medicaid
WA8850636Medicare PIN