Provider Demographics
NPI:1851323604
Name:JANUS, KATHLEEN A (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:JANUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 SIX FORKS RD
Mailing Address - Street 2:STE 260
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-846-9292
Mailing Address - Fax:919-848-3638
Practice Address - Street 1:7320 SIX FORKS RD
Practice Address - Street 2:STE 260
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-846-9292
Practice Address - Fax:919-848-3638
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10394OtherBCBS-NORTH CAROLINA
NC8910394Medicaid
NC2342881Medicare ID - Type Unspecified
NC8910394Medicaid