Provider Demographics
NPI:1194368399
Name:DEMILLE, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:DEMILLE
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 1:432 JOHN SWAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEBO
Mailing Address - State:NC
Mailing Address - Zip Code:28761-6732
Mailing Address - Country:US
Mailing Address - Phone:207-232-7963
Mailing Address - Fax:
Practice Address - Street 1:432 JOHN SWAFFORD RD
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761-6732
Practice Address - Country:US
Practice Address - Phone:207-232-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer