1235483322 NPI number — JANELYN C JOUETT

Table of content: JANELYN C JOUETT (NPI 1235483322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235483322 NPI number — JANELYN C JOUETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOUETT
Provider First Name:
JANELYN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235483322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 W CHEYENNE AVE
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89030-7807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-719-9773
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 W CHEYENNE AVE
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-7807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-719-9773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1404248939 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".