Provider Demographics
NPI:1265468144
Name:ROSENQUIST, JANET ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ANNE
Last Name:ROSENQUIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83353-2357
Mailing Address - Country:US
Mailing Address - Phone:208-727-8100
Mailing Address - Fax:208-727-8124
Practice Address - Street 1:100 HOSPITAL DRIVE.
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-727-8100
Practice Address - Fax:208-727-8124
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4604207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003902800Medicaid
IDE46420Medicare UPIN
ID1123838Medicare ID - Type Unspecified