Provider Demographics
NPI:1467808758
Name:JANZ-NAVARRO, PRAKRITI PRASHANTA (NP)
Entity Type:Individual
Prefix:MS
First Name:PRAKRITI
Middle Name:PRASHANTA
Last Name:JANZ-NAVARRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:PRAKRITI
Other - Middle Name:PRASHANTA
Other - Last Name:JANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1524 MCHENRY AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4500
Mailing Address - Country:US
Mailing Address - Phone:209-575-5801
Mailing Address - Fax:209-575-1115
Practice Address - Street 1:1524 MCHENRY AVE STE 135
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4569
Practice Address - Country:US
Practice Address - Phone:209-575-5801
Practice Address - Fax:209-575-1115
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily