Provider Demographics
NPI:1245588896
Name:JANOWIEC, CALLAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:CALLAN
Middle Name:
Last Name:JANOWIEC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAKESIDE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5906
Mailing Address - Country:US
Mailing Address - Phone:802-448-9719
Mailing Address - Fax:802-660-9438
Practice Address - Street 1:75 TALCOTT RD STE 10
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8122
Practice Address - Country:US
Practice Address - Phone:802-879-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0089677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily