Provider Demographics
NPI:1457304545
Name:MIGON, JANICE A (APN, CRNA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:MIGON
Suffix:
Gender:F
Credentials:APN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S DEE RD
Mailing Address - Street 2:UNIT F
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3754
Mailing Address - Country:US
Mailing Address - Phone:847-698-7719
Mailing Address - Fax:
Practice Address - Street 1:60 S DEE RD
Practice Address - Street 2:UNIT F
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3754
Practice Address - Country:US
Practice Address - Phone:847-698-7719
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR40486Medicare UPIN