Provider Demographics
NPI:1811015027
Name:HACKETT, JANICE K (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:K
Last Name:HACKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 E ANTELOPE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93286-1506
Mailing Address - Country:US
Mailing Address - Phone:559-564-3538
Mailing Address - Fax:559-564-8411
Practice Address - Street 1:180 E ANTELOPE AVE
Practice Address - Street 2:
Practice Address - City:WOODLAKE
Practice Address - State:CA
Practice Address - Zip Code:93286-1506
Practice Address - Country:US
Practice Address - Phone:559-564-3538
Practice Address - Fax:559-564-8411
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13848208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89202Medicare UPIN