Basic Information
| Provider Information | |||||||||
| NPI: | 1093363764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACGOWAN | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | LYNETTE | ||||||||
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| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6200 SAND POINT WAY NE APT 411 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981157969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064712792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 SW HOLDEN ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062576600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2019 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN00092269 | WA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.