Provider Demographics
NPI:1326007519
Name:CASPERSON, JANET (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:CASPERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 LAKE AVENUE
Mailing Address - Street 2:ROOM 345
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805
Mailing Address - Country:US
Mailing Address - Phone:260-426-5431
Mailing Address - Fax:260-460-1385
Practice Address - Street 1:2121 LAKE AVENUE
Practice Address - Street 2:ROOM 345
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:260-426-5431
Practice Address - Fax:260-460-1385
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000792A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200290840Medicaid
IN000000530312OtherANTHEM BC/BS
IN200290840Medicaid
INP02803Medicare UPIN
IN136140TMedicare PIN