Provider Demographics
NPI:1609243062
Name:SANDWATER, JANIECE (RN60483287)
Entity Type:Individual
Prefix:
First Name:JANIECE
Middle Name:
Last Name:SANDWATER
Suffix:
Gender:F
Credentials:RN60483287
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E HEMMI RD
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-9777
Mailing Address - Country:US
Mailing Address - Phone:360-371-7152
Mailing Address - Fax:
Practice Address - Street 1:1000 E HEMMI RD
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9777
Practice Address - Country:US
Practice Address - Phone:360-815-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60483287163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse