Provider Demographics
NPI:1700421682
Name:FOOTE, JANELLE S (MEDICAL ASSISTANCE)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:S
Last Name:FOOTE
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36540 HIGHWAY 140
Mailing Address - Street 2:
Mailing Address - City:BEATTY
Mailing Address - State:OR
Mailing Address - Zip Code:97621-9706
Mailing Address - Country:US
Mailing Address - Phone:541-591-1863
Mailing Address - Fax:
Practice Address - Street 1:36540 HIGHWAY 140
Practice Address - Street 2:
Practice Address - City:BEATTY
Practice Address - State:OR
Practice Address - Zip Code:97621-9706
Practice Address - Country:US
Practice Address - Phone:541-591-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374U00000X
OR251E00000X374U00000X
OR374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health