Provider Demographics
NPI:1093188773
Name:JANOWSKY, MICHELLE S (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:JANOWSKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27B TALISMAN DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-7914
Mailing Address - Country:US
Mailing Address - Phone:970-372-0456
Mailing Address - Fax:705-073-0109
Practice Address - Street 1:27B TALISMAN DR UNIT 3
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-7914
Practice Address - Country:US
Practice Address - Phone:970-372-0456
Practice Address - Fax:970-507-3010
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA2944363A00000X, 363AS0400X
COPA.0005277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019406Medicaid
TN1039I73305Medicare PIN