Provider Demographics
NPI:1659935070
Name:PEDERSEN, JANINE (APNP-CNP)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:APNP-CNP
Other - Prefix:MRS
Other - First Name:JANINE
Other - Middle Name:PEDERSEN
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:APC MAIN
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-5435
Practice Address - Fax:401-444-8301
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02032363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology