Provider Demographics
NPI:1891945481
Name:JANICEK, KRISTIN MICHELLE (SA-C, CST)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:JANICEK
Suffix:
Gender:F
Credentials:SA-C, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27646 N 62ND PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-8757
Mailing Address - Country:US
Mailing Address - Phone:480-335-6785
Mailing Address - Fax:480-907-7544
Practice Address - Street 1:7400 E THOMPSON PEAK PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4109
Practice Address - Country:US
Practice Address - Phone:480-335-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist