Provider Demographics
NPI:1093736365
Name:ADASIAK, JANETTE PETERSON (ANP)
Entity Type:Individual
Prefix:MS
First Name:JANETTE
Middle Name:PETERSON
Last Name:ADASIAK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:ADASIAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:1835 CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5117
Mailing Address - Country:US
Mailing Address - Phone:907-562-0401
Mailing Address - Fax:907-563-4854
Practice Address - Street 1:610 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99950
Practice Address - Country:US
Practice Address - Phone:907-274-0352
Practice Address - Fax:907-274-3429
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK266363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP70111Medicaid
150622OtherTRANSAMERICA BILLING CODE
AKNP70111Medicaid