Provider Demographics
NPI:1982629333
Name:JANES, JANE M (FNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:JANES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62858-0246
Mailing Address - Country:US
Mailing Address - Phone:618-665-4500
Mailing Address - Fax:618-665-4050
Practice Address - Street 1:935 BRYANT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:IL
Practice Address - Zip Code:62839
Practice Address - Country:US
Practice Address - Phone:618-665-4500
Practice Address - Fax:618-665-4050
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
K24972Medicare ID - Type UnspecifiedMEMBER NUMBER