Provider Demographics
NPI:1932108347
Name:MEYER, JANAI MARIE (RD, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JANAI
Middle Name:MARIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CARLANNA LAKE RD LOWR
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5611
Mailing Address - Country:US
Mailing Address - Phone:907-220-9920
Mailing Address - Fax:907-220-9925
Practice Address - Street 1:130 CARLANNA LAKE RD LOWR
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5611
Practice Address - Country:US
Practice Address - Phone:907-220-9920
Practice Address - Fax:907-220-9925
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK40133V00000X
AKL-45481174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1003924Medicaid