Provider Demographics
NPI:1154823755
Name:MISSLER, JANELL DAWN
Entity Type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:DAWN
Last Name:MISSLER
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 1:1348 COUNTY ROAD 44
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MN
Mailing Address - Zip Code:55382-9112
Mailing Address - Country:US
Mailing Address - Phone:763-464-6701
Mailing Address - Fax:320-274-2419
Practice Address - Street 1:1348 COUNTY ROAD 44
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MN
Practice Address - Zip Code:55382-9112
Practice Address - Country:US
Practice Address - Phone:763-464-6701
Practice Address - Fax:320-274-2419
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1092678-1-HCBS253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency