Provider Demographics
NPI:1740393305
Name:FOGLESONG, JANET ARLENE (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ARLENE
Last Name:FOGLESONG
Suffix:
Gender:F
Credentials:NP
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 1690
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-1690
Mailing Address - Country:US
Mailing Address - Phone:219-326-2312
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:1300 STATE STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3134
Practice Address - Country:US
Practice Address - Phone:219-326-5700
Practice Address - Fax:219-326-8131
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001946A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200495860Medicaid