Provider Demographics
NPI:1578524559
Name:FRANCO, JANINE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:FRANCO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 12TH AVE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6182
Mailing Address - Country:US
Mailing Address - Phone:208-442-8035
Mailing Address - Fax:
Practice Address - Street 1:1611 12TH AVE RD STE B
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6182
Practice Address - Country:US
Practice Address - Phone:208-442-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA329363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8058289Medicaid
P16341Medicare UPIN
1666855Medicare ID - Type UnspecifiedCIGNA
1666858Medicare ID - Type UnspecifiedCIGNA
1666856Medicare ID - Type UnspecifiedCIGNA
ID8058289Medicaid