Provider Demographics
NPI:1639670342
Name:GRENIER, JANELL
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:GRENIER
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:PO BOX 6943
Mailing Address - Street 2:
Mailing Address - City:NIKISKI
Mailing Address - State:AK
Mailing Address - Zip Code:99635-6943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10815 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:NIKISKI
Practice Address - State:AK
Practice Address - Zip Code:99611-7848
Practice Address - Country:US
Practice Address - Phone:907-776-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK118059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist