Provider Demographics
NPI:1356329288
Name:GOTHRO, JANET S (FNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:GOTHRO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:S
Other - Last Name:CLAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,FNP
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6490 EXCELSIOR BLVD
Practice Address - Street 2:STE E111
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4705
Practice Address - Country:US
Practice Address - Phone:952-993-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 099116-4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS19512Medicare UPIN