Provider Demographics
NPI:1437433711
Name:IRVIN, JANELLE L (HMC)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:L
Last Name:IRVIN
Suffix:
Gender:F
Credentials:HMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 W 118TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6582
Mailing Address - Country:US
Mailing Address - Phone:913-596-8303
Mailing Address - Fax:913-538-6262
Practice Address - Street 1:14405 W 118TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6582
Practice Address - Country:US
Practice Address - Phone:913-596-8303
Practice Address - Fax:913-538-6262
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-41360-111 IV171M00000X
KS2441360111IV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator