Basic Information
| Provider Information | |||||||||
| NPI: | 1194817700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NESS | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RANDA | ||||||||
| OtherFirstName: | JANET | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ARNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 77 WAINWRIGHT DR. | ||||||||
| Address2: | JONATHAN M. WAINWRIGHT MEDICAL CENTER | ||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255200 | ||||||||
| FaxNumber: | 9072603697 | ||||||||
| Practice Location | |||||||||
| Address1: | 717 FRUITVALE BLVD | ||||||||
| Address2: | YAKIMA COMMUNITY BASED OUTPT. CLINIC (CBOC) | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099660199 | ||||||||
| FaxNumber: | 5099664266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 12/27/2012 | ||||||||
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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 | 363LP0808X | 737 | AK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | AP60095267 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | RH177FQ | 05 | AK | MEDICAID | MH0156 | 05 | AK | MEDICAID |