Provider Demographics
NPI:1881666394
Name:MISAK, JANENE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANENE
Middle Name:
Last Name:MISAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3403
Mailing Address - Country:US
Mailing Address - Phone:563-742-5900
Mailing Address - Fax:563-742-5980
Practice Address - Street 1:3540 E 46TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3403
Practice Address - Country:US
Practice Address - Phone:563-742-5900
Practice Address - Fax:563-742-5980
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000687363A00000X
IL85-000564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant