Provider Demographics
NPI:1396181228
Name:LANDIS, JANELLE G (RN, APN)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:G
Last Name:LANDIS
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:LANDIS
Other - Last Name:KHESHGI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, APN
Mailing Address - Street 1:34 PARKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4930
Mailing Address - Country:US
Mailing Address - Phone:847-724-6863
Mailing Address - Fax:
Practice Address - Street 1:5425 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2342
Practice Address - Country:US
Practice Address - Phone:630-908-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.167806163WL0100X
IL209.006690163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant