Provider Demographics
NPI:1821297714
Name:GENDRON, JANIS ANN (RN,C)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:ANN
Last Name:GENDRON
Suffix:
Gender:F
Credentials:RN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-5789
Mailing Address - Country:US
Mailing Address - Phone:417-257-9152
Mailing Address - Fax:417-257-9162
Practice Address - Street 1:3411 DIVISION DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-5789
Practice Address - Country:US
Practice Address - Phone:417-257-9152
Practice Address - Fax:417-257-9162
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142290163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)