Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OP00001585 | WA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OP00001585 | WA |
NPI | 1730190547 |
---|---|
Provider Name | Janis E Fegley |
First Address | Tacoma, WA 98405-5307 |
Second Address | Tacoma, WA 98405-5307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080188807 | RAILROAD (01) | WA |
1045430 | (05) | WA |
134463 | L & I (01) | WA |
154703 | L & I (01) | WA |
80154076 | RAILROAD (01) | WA |
8248742 | (05) | WA |
8928707 | CRIME VICTIMS (01) | WA |
8936339 | CRIME VICTIMS (01) | WA |
E53386 | (02) |