Provider Demographics
NPI:1205417532
Name:JANECKO, APRIL DORICE (LPN)
Entity Type:Individual
Prefix:MS
First Name:APRIL
Middle Name:DORICE
Last Name:JANECKO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 N STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4188
Mailing Address - Country:US
Mailing Address - Phone:928-377-5903
Mailing Address - Fax:
Practice Address - Street 1:2395 SMOKETREE AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5876
Practice Address - Country:US
Practice Address - Phone:928-505-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ248465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
9284126335OtherNURSING