Provider Demographics
NPI:1922438803
Name:ALLRED, JANELLE
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:ALLRED
Suffix:
Gender:F
Credentials:
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 410047
Mailing Address - Street 2:
Mailing Address - City:PINESDALE
Mailing Address - State:MT
Mailing Address - Zip Code:59841-0047
Mailing Address - Country:US
Mailing Address - Phone:406-544-9255
Mailing Address - Fax:
Practice Address - Street 1:93 N WILLOW WAY
Practice Address - Street 2:
Practice Address - City:PINESDALE
Practice Address - State:MT
Practice Address - Zip Code:59841-0047
Practice Address - Country:US
Practice Address - Phone:406-544-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-MID-LIC-973176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife