Provider Demographics
NPI:1679368815
Name:FOGDALL, JANE ANN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:FOGDALL
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 SW TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3643
Mailing Address - Country:US
Mailing Address - Phone:206-777-5532
Mailing Address - Fax:
Practice Address - Street 1:4727 44TH AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4467
Practice Address - Country:US
Practice Address - Phone:206-763-2733
Practice Address - Fax:206-763-2122
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-15451163WL0100X
WARN00129803163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse