Provider Demographics
NPI:1164412086
Name:WILMOT, JANICE SPENCE (APRN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:SPENCE
Last Name:WILMOT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:ROSE
Other - Last Name:SPENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6529 FORZA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3150
Mailing Address - Country:US
Mailing Address - Phone:702-658-4250
Mailing Address - Fax:
Practice Address - Street 1:6529 FORZA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3150
Practice Address - Country:US
Practice Address - Phone:702-658-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24423163W00000X
AL1-029211163W00000X, 363LW0102X
NVRN60377163W00000X
AK836363LW0102X
NVTAPN700482363LW0102X
NVAPN001099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164412086Medicaid
AKNP1697Medicaid
Q26861Medicare UPIN
NV1164412086Medicaid
AKNP1697Medicaid