Provider Demographics
NPI:1043213507
Name:STABLES, JANICE L (MSN, ANP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:STABLES
Suffix:
Gender:F
Credentials:MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 AIRPORT WAY
Mailing Address - Street 2:STE 110B
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4054
Mailing Address - Country:US
Mailing Address - Phone:907-452-6330
Mailing Address - Fax:907-452-6335
Practice Address - Street 1:1867 AIRPORT WAY
Practice Address - Street 2:STE 110B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4054
Practice Address - Country:US
Practice Address - Phone:907-452-6330
Practice Address - Fax:907-452-6335
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK420363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK152456OtherINDIVIDUAL MEDICARE PIN
AKNP0420-1Medicaid
AKK152456OtherINDIVIDUAL MEDICARE PIN
AKNP0420-1Medicaid