Basic Information
| Provider Information | |||||||||
| NPI: | 1497220420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLEMING | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | RN00056540 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 39680 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984963680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535033666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9720 S TACOMA WAY | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984994456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535033666 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2018 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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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 | 163W00000X | RN.0000056540 | WA | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 2001900 | 05 | WA | MEDICAID |