Provider Demographics
NPI:1073173084
Name:MADERAZO, JANELLE CARLA
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:CARLA
Last Name:MADERAZO
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 1:615A GALE ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5955
Mailing Address - Country:US
Mailing Address - Phone:956-712-9988
Mailing Address - Fax:
Practice Address - Street 1:615A GALE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5955
Practice Address - Country:US
Practice Address - Phone:956-712-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX892384163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse