Provider Demographics
NPI:1891471801
Name:ELIADIS, JANET ROSE (RN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ROSE
Last Name:ELIADIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:ROSE
Other - Last Name:CLISSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1723 16TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-8500
Mailing Address - Country:US
Mailing Address - Phone:717-809-7589
Mailing Address - Fax:
Practice Address - Street 1:39 12TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4339
Practice Address - Country:US
Practice Address - Phone:304-424-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV112699163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health