Provider Demographics
NPI:1558834408
Name:JETER, JANICE REBECCA
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:REBECCA
Last Name:JETER
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 1:828A HIGHWAY 277
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-2517
Mailing Address - Country:US
Mailing Address - Phone:850-415-6422
Mailing Address - Fax:
Practice Address - Street 1:828A HIGHWAY 277
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-2517
Practice Address - Country:US
Practice Address - Phone:850-415-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant