Provider Demographics
NPI:1013366137
Name:CAROL, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:CAROL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13433 HADDON ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1156
Mailing Address - Country:US
Mailing Address - Phone:810-428-1745
Mailing Address - Fax:
Practice Address - Street 1:13433 HADDON ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1156
Practice Address - Country:US
Practice Address - Phone:810-428-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704120701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse