Provider Demographics
NPI:1801840947
Name:TABET, JANELLE M (PA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:M
Last Name:TABET
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:M
Other - Last Name:REKLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:875 AIRPORT PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1085
Mailing Address - Country:US
Mailing Address - Phone:317-926-3739
Mailing Address - Fax:317-921-7478
Practice Address - Street 1:875 AIRPORT PKWY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1085
Practice Address - Country:US
Practice Address - Phone:317-926-3739
Practice Address - Fax:317-921-7478
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99031528A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26119Medicare PIN
ILQ65651Medicare UPIN
ILK26118Medicare PIN