Provider Demographics
NPI:1083990535
Name:DIFFEY, JANET JEANENNE (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:JEANENNE
Last Name:DIFFEY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4326
Mailing Address - Country:US
Mailing Address - Phone:314-752-9799
Mailing Address - Fax:
Practice Address - Street 1:3722 TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-4326
Practice Address - Country:US
Practice Address - Phone:314-752-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011035322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner