Provider Demographics
NPI:1467815498
Name:JANIS, ORREN P SR (LSP)
Entity Type:Individual
Prefix:MR
First Name:ORREN
Middle Name:P
Last Name:JANIS
Suffix:SR
Gender:M
Credentials:LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10369 HWY 789
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:US
Mailing Address - Phone:307-856-9940
Mailing Address - Fax:307-333-0497
Practice Address - Street 1:10369 HIGHWAY 789
Practice Address - Street 2:10369 HWY 789
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501
Practice Address - Country:US
Practice Address - Phone:307-856-9940
Practice Address - Fax:307-333-0497
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker