Provider Demographics
NPI:1912991332
Name:LINEHAN, JANICE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:LINEHAN
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 1:509 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-8964
Mailing Address - Country:US
Mailing Address - Phone:509-935-6001
Mailing Address - Fax:509-935-4196
Practice Address - Street 1:509 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8964
Practice Address - Country:US
Practice Address - Phone:509-935-6001
Practice Address - Fax:509-935-4196
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9625757Medicaid
WA197187OtherLABOR INDUSTRY
WA197187OtherLABOR INDUSTRY
WA9625757Medicaid