Provider Demographics
NPI:1790070464
Name:GUNDEL, JANINE ALANE (APRN, AOCNS)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:ALANE
Last Name:GUNDEL
Suffix:
Gender:F
Credentials:APRN, AOCNS
Other - Prefix:MS
Other - First Name:JANINE
Other - Middle Name:ALANE
Other - Last Name:FIGALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, AOCNS
Mailing Address - Street 1:1650 S TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4474
Mailing Address - Country:US
Mailing Address - Phone:208-605-7070
Mailing Address - Fax:
Practice Address - Street 1:7416 212TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7602
Practice Address - Country:US
Practice Address - Phone:425-245-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61034013364SX0200X, 364SP0808X, 364S00000X
WA4013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2165OtherSTATE CNS CERTIFICATION