Provider Demographics
NPI:1558923227
Name:HANEY, JANA MICHELLE
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MICHELLE
Last Name:HANEY
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 1:7348 E LAREDO LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6473
Mailing Address - Country:US
Mailing Address - Phone:512-431-7197
Mailing Address - Fax:
Practice Address - Street 1:9787 N 91ST ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5088
Practice Address - Country:US
Practice Address - Phone:480-563-6400
Practice Address - Fax:480-563-8009
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ228550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine