Provider Demographics
NPI:1689683930
Name:SACK-ORY, JANICE M (ARNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:SACK-ORY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34709 9TH AVE S
Mailing Address - Street 2:STE B-500
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6789
Mailing Address - Country:US
Mailing Address - Phone:253-944-6950
Mailing Address - Fax:253-661-8603
Practice Address - Street 1:34709 9TH AVE S
Practice Address - Street 2:STE B-500
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6789
Practice Address - Country:US
Practice Address - Phone:253-944-6950
Practice Address - Fax:253-661-8603
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000117363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8936934OtherSTATE CRIME VICTIMS
WA0194359OtherSTATE L&I
WA0160003OtherSTATE L&I
WA160043862OtherMEDICARE RAILROAD
WA9634502Medicaid
WA0160003OtherSTATE L&I
WAGAB28952Medicare PIN
WA8936934OtherSTATE CRIME VICTIMS