Provider Demographics
NPI:1154645778
Name:SLEDGE, JANETTA RENEE
Entity Type:Individual
Prefix:MRS
First Name:JANETTA
Middle Name:RENEE
Last Name:SLEDGE
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 1:1901 NE 67TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73111
Mailing Address - Country:US
Mailing Address - Phone:405-923-5933
Mailing Address - Fax:
Practice Address - Street 1:1901 NE 67TH
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73111
Practice Address - Country:US
Practice Address - Phone:405-923-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker