Provider Demographics
NPI:1184870222
Name:GANJEH, JANET (RNFA)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:GANJEH
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:GANJEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2717 SAGEMILL DR.
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8615
Mailing Address - Country:US
Mailing Address - Phone:209-551-3170
Mailing Address - Fax:209-551-3170
Practice Address - Street 1:1700 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-526-4500
Practice Address - Fax:209-551-3170
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN352732163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
563571340OtherREGISTERED NURSE FIRST ASSISTANT PROVIDER ID