Provider Demographics
NPI:1265962880
Name:UFFELMAN, JANNA ALINA BROCK (RN)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:ALINA BROCK
Last Name:UFFELMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S 2ND ST STE 301
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3879
Mailing Address - Country:US
Mailing Address - Phone:360-399-9209
Mailing Address - Fax:
Practice Address - Street 1:700 S 2ND ST STE 301
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3879
Practice Address - Country:US
Practice Address - Phone:360-399-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00174356163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse