Provider Demographics
NPI:1972753432
Name:STOUDENMIRE-JUETT, JANET (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:STOUDENMIRE-JUETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:STOUDENMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:502-587-4784
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-1735
Practice Address - Fax:502-852-6056
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI248236-30367500000X
AL1-043032367500000X
TN33884367500000X
KY3014553367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300037626Medicaid
KY7100661390Medicaid