Provider Demographics
NPI:1184666836
Name:KOMOROWSKI, JANELLE A (DNP, CNM)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:A
Last Name:KOMOROWSKI
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:ANNE
Other - Last Name:WAHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CNM
Mailing Address - Street 1:JANELLE KOMOROWSKI, DNP, CNM
Mailing Address - Street 2:1716 SWISS VALLEY ROAD
Mailing Address - City:ADDY
Mailing Address - State:WA
Mailing Address - Zip Code:99101
Mailing Address - Country:US
Mailing Address - Phone:509-418-0002
Mailing Address - Fax:509-769-0998
Practice Address - Street 1:JANELLE KOMOROWSKI, DNP, CNM
Practice Address - Street 2:1716 SWISS VALLEY ROAD
Practice Address - City:ADDY
Practice Address - State:WA
Practice Address - Zip Code:99101
Practice Address - Country:US
Practice Address - Phone:509-418-0002
Practice Address - Fax:509-769-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005983367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30005983OtherAPRN LICENSE
CO72277556Medicaid
COCOAAA0119Medicare PIN