Provider Demographics
NPI:1093814816
Name:PFOTENHAUER, JANICE L (CRNA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:PFOTENHAUER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 RIVERCHASE DR.
Mailing Address - Street 2:PHENIX CITY
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 ST ANDREWS WAY
Practice Address - Street 2:PHENIX CITY
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7413
Practice Address - Country:US
Practice Address - Phone:334-448-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN27929367500000X
AL1-116825367500000X
GARN196515367500000X
TX551327367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered