Provider Demographics
NPI:1285636043
Name:ZDANUK DODD, JANETTE M (DNP, FNP, CWS)
Entity Type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:M
Last Name:ZDANUK DODD
Suffix:
Gender:F
Credentials:DNP, FNP, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 BRENDEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3885
Mailing Address - Country:US
Mailing Address - Phone:817-235-9957
Mailing Address - Fax:
Practice Address - Street 1:1301 W 7TH ST
Practice Address - Street 2:SUITE 121
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2651
Practice Address - Country:US
Practice Address - Phone:817-348-0425
Practice Address - Fax:817-348-0455
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX445715363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1122640-04OtherMEDICAID TPI
TX8F21186OtherMEDICARE ID
TX01269303OtherAMERIGROUP