Provider Demographics
NPI:1275176919
Name:ANDERSON, JANELLE M
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:M
Last Name:ANDERSON
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 1:5104 W SUNLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2429
Mailing Address - Country:US
Mailing Address - Phone:602-587-7179
Mailing Address - Fax:
Practice Address - Street 1:BERMUDA PALMS
Practice Address - Street 2:HC 20
Practice Address - City:EARP
Practice Address - State:CA
Practice Address - Zip Code:92242
Practice Address - Country:US
Practice Address - Phone:602-587-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide