Provider Demographics
NPI:1861686859
Name:MCCORMICK, JANELLE KAY (RN)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:KAY
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RED MESA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-1597
Mailing Address - Country:US
Mailing Address - Phone:970-242-3302
Mailing Address - Fax:
Practice Address - Street 1:222 S 6TH ST
Practice Address - Street 2:COLORADO DEPARTMENT OF HEALTH
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2704
Practice Address - Country:US
Practice Address - Phone:970-248-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96666163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse