Provider Demographics
NPI:1689733412
Name:TIVEL, JANET E (ARNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:TIVEL
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 1:19695 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8198
Mailing Address - Country:US
Mailing Address - Phone:360-421-7427
Mailing Address - Fax:360-299-8605
Practice Address - Street 1:715 SEAFARERS WAY
Practice Address - Street 2:STE 201B
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2257
Practice Address - Country:US
Practice Address - Phone:360-588-1460
Practice Address - Fax:360-588-1473
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001131363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9600032Medicaid
AB11368Medicare PIN
S90289Medicare UPIN