Provider Demographics
NPI:1821201005
Name:MORDARSKI, JANET (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MORDARSKI
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 1:20 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2912
Mailing Address - Country:US
Mailing Address - Phone:207-874-8445
Mailing Address - Fax:
Practice Address - Street 1:389 CONGRESS ST
Practice Address - Street 2:ROOM 307
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3509
Practice Address - Country:US
Practice Address - Phone:207-874-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER053092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432540499Medicaid