Provider Demographics
NPI:1942392063
Name:VANDEHEI, JANICE R
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:R
Last Name:VANDEHEI
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:W2143 OLD PESHTIGO ROAD
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-9708
Mailing Address - Country:US
Mailing Address - Phone:715-735-7807
Mailing Address - Fax:
Practice Address - Street 1:W2143 OLD PESHTIGO ROAD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-9708
Practice Address - Country:US
Practice Address - Phone:715-735-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5927750001Medicare NSC
WI5927750001Medicare PIN