Provider Demographics
NPI:1184686396
Name:BEAUDUY, JANICE EILENE (MD, MS)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:EILENE
Last Name:BEAUDUY
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:EILENE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:10830 MAJOR AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2295
Mailing Address - Country:US
Mailing Address - Phone:218-290-3320
Mailing Address - Fax:
Practice Address - Street 1:10830 MAJOR AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2295
Practice Address - Country:US
Practice Address - Phone:218-290-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32492207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B53553Medicare UPIN