Provider Demographics
NPI:1326347782
Name:STRUCKEL, JANA (MD)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:STRUCKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:STRUCKELOVA
Other - Last Name:CLAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30809 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4074
Mailing Address - Country:US
Mailing Address - Phone:253-839-2030
Mailing Address - Fax:253-839-1071
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:253-596-3300
Practice Address - Fax:253-596-3301
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60484342207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038557Medicaid
WAG8931791Medicare PIN