Provider Demographics
NPI:1548760143
Name:CHURCHMAN, JANICE KAY
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:KAY
Last Name:CHURCHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 COUNTY ROAD 430
Mailing Address - Street 2:
Mailing Address - City:JOAQUIN
Mailing Address - State:TX
Mailing Address - Zip Code:75954-1211
Mailing Address - Country:US
Mailing Address - Phone:936-205-6976
Mailing Address - Fax:
Practice Address - Street 1:131 COUNTY ROAD 3102
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-5581
Practice Address - Country:US
Practice Address - Phone:936-591-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166677164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse