Provider Demographics
NPI:1760726467
Name:FRY, JANELLE KATE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:KATE
Last Name:FRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:KATE
Other - Last Name:HENKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAIL CODE SJH-2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-7246
Mailing Address - Fax:503-494-8368
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-7641
Practice Address - Fax:503-494-4661
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA-01251163W00000X
WAAP61028430367500000X
PARN615293367500000X
OR201407791CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse