Provider Demographics
NPI:1255423380
Name:AHEARN, JANE LYNELL (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LYNELL
Last Name:AHEARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LYNELL
Other - Last Name:RAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:406-C SE 131ST AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4004
Mailing Address - Country:US
Mailing Address - Phone:360-892-4024
Mailing Address - Fax:360-892-4159
Practice Address - Street 1:406-C SE 131ST AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-892-4024
Practice Address - Fax:360-892-4159
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030075207VG0400X
ORMD16405207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1113752Medicaid
OR008453OtherOMAP
WA1113752Medicaid
E68577Medicare UPIN