Provider Demographics
NPI:1598920738
Name:JANIS, AMBER NICOLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:JANIS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1201
Mailing Address - Country:US
Mailing Address - Phone:605-867-3056
Mailing Address - Fax:
Practice Address - Street 1:E. HWY 18, 4500 HOSPITAL DRIVE
Practice Address - Street 2:PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3018363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health