Provider Demographics
NPI:1346994746
Name:JANSKI, ANDRIA LAILA
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:LAILA
Last Name:JANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:LAILA
Other - Last Name:ZAIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6360 BROADBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-2601
Mailing Address - Country:US
Mailing Address - Phone:810-580-1948
Mailing Address - Fax:
Practice Address - Street 1:6360 BROADBRIDGE RD
Practice Address - Street 2:
Practice Address - City:COTTRELLVILLE
Practice Address - State:MI
Practice Address - Zip Code:48039-2601
Practice Address - Country:US
Practice Address - Phone:810-580-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant