Provider Demographics
NPI:1548402308
Name:SOUSA, JANELLE DUBBINS (MD)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:DUBBINS
Last Name:SOUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:ASHLEY
Other - Last Name:DUBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:820 S MCCLELLAN ST STE 118
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2446
Practice Address - Country:US
Practice Address - Phone:509-464-7880
Practice Address - Fax:509-464-7961
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD602249202086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1548402308Medicaid
WA1548402308Medicaid