Provider Demographics
NPI:1174692776
Name:KUBOTA, JANET R (ARNP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:R
Last Name:KUBOTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 ISLAND DR S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4733
Mailing Address - Country:US
Mailing Address - Phone:206-725-2782
Mailing Address - Fax:206-205-6236
Practice Address - Street 1:10821 8TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2225
Practice Address - Country:US
Practice Address - Phone:206-205-7250
Practice Address - Fax:206-205-6236
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001041363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8580409Medicaid
WA8580409Medicaid