Provider Demographics
NPI:1851833669
Name:STUCKRATH, JANA (DNP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:STUCKRATH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:GILLIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:105 W 8TH AVE STE 6050
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2312
Practice Address - Country:US
Practice Address - Phone:509-455-8866
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60687169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily