Provider Demographics
NPI:1609203249
Name:FAWCETT, JANICE LYNNE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LYNNE
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212W SUPERSTITION BLVD 101
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-4127
Mailing Address - Country:US
Mailing Address - Phone:480-398-1228
Mailing Address - Fax:480-398-1238
Practice Address - Street 1:20851 E. RITTENHOUSE RD.
Practice Address - Street 2:E103
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-707-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2911363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health