1639310279 NPI number — JANET RENEE ADER MSN,FNP-BC

Table of content: JANET RENEE ADER MSN,FNP-BC (NPI 1639310279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639310279 NPI number — JANET RENEE ADER MSN,FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADER
Provider First Name:
JANET
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN,FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOTTRILL
Provider Other First Name:
JANET
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639310279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 HOUGHTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-583-6800
Provider Business Mailing Address Fax Number:
989-583-6955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5421 COLONY DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-790-3141
Provider Business Practice Location Address Fax Number:
989-583-6955
Provider Enumeration Date:
03/11/2009

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: 363L00000X , with the licence number:  4704215299 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 381908328-432 . This is a "CARE SOURCE OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 174506 . This is a "GREAT LAKES HEALTH PLAN/UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 53837 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1639310279 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1046914 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1639310279 . This is a "MOLINA HEALTHCARE OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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