Provider Demographics
NPI:1861654675
Name:VANDEVEER, JANICE A (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:VANDEVEER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:650 OAK AVE
Practice Address - Street 2:
Practice Address - City:NEOGA
Practice Address - State:IL
Practice Address - Zip Code:62447
Practice Address - Country:US
Practice Address - Phone:217-895-2222
Practice Address - Fax:217-895-3598
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine