Basic Information
| Provider Information | |||||||||
| NPI: | 1043529985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANDER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHAPMAN | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 16TH AVENUE EAST | ||||||||
| Address2: | CAPITOL HILL MAIN BUILDING | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981125260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063263000 | ||||||||
| FaxNumber: | 2063262785 | ||||||||
| Practice Location | |||||||||
| Address1: | 4011 TALBOT RD S | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980555773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256565060 | ||||||||
| FaxNumber: | 4256565047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 06/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA60178763 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | PA60178763 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 0289787 | 01 | WA | LNI POA | OTHER | P01037373 | 01 | WA | MEDICARE RR POA | OTHER | G8895131 | 01 | MEDICARE PTAN NWSS | OTHER | 270410 | 01 | WA | L & I NWSS | OTHER | G8906345 | 01 | WA | MEDICARE PTAN POA | OTHER |