Provider Demographics
NPI:1780664946
Name:MINISH, JANE ANDREA (RN, BSN, CNOR, CRNFA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANDREA
Last Name:MINISH
Suffix:
Gender:F
Credentials:RN, BSN, CNOR, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-0239
Mailing Address - Country:US
Mailing Address - Phone:360-531-0951
Mailing Address - Fax:
Practice Address - Street 1:2520 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4229
Practice Address - Country:US
Practice Address - Phone:360-531-0951
Practice Address - Fax:360-437-9162
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00056165163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635079Medicaid
WA201937463-01OtherKPS
WA0161212OtherWASHINGTON STATE L&I
WA5902MIOtherREGENCE BLUE CROSS