Basic Information
| Provider Information | |||||||||
| NPI: | 1689733412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIVEL | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19695 LANDING RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982738198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604217427 | ||||||||
| FaxNumber: | 3602998605 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 SEAFARERS WAY | ||||||||
| Address2: | STE 201B | ||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605881460 | ||||||||
| FaxNumber: | 3605881473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2006 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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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 | 363L00000X | AP30001131 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 9600032 | 05 | WA | MEDICAID |