Provider Demographics
NPI:1659340099
Name:VANZANDT, JANELLE (MD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:VANZANDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 HARRISON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7318
Mailing Address - Country:US
Mailing Address - Phone:870-307-0488
Mailing Address - Fax:870-307-0916
Practice Address - Street 1:1699 HARRISON ST
Practice Address - Street 2:SUITE D
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7318
Practice Address - Country:US
Practice Address - Phone:870-307-0488
Practice Address - Fax:870-307-0916
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE02492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125729001Medicaid
AR5J500G676Medicare PIN
ARF86140Medicare UPIN