Provider Demographics
NPI:1326077124
Name:CARMODY, JANIS (CRNP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:CARMODY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:978-536-7850
Mailing Address - Fax:877-280-9727
Practice Address - Street 1:100 BROOKSBY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1438
Practice Address - Country:US
Practice Address - Phone:978-536-7850
Practice Address - Fax:877-280-9727
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117989363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0706329Medicaid
8302607OtherEVERCARE
NP2494OtherBCBS MA
P09624Medicare UPIN
P00348826Medicare PIN
NP2494OtherBCBS MA