Provider Demographics
NPI:1255937710
Name:ALTENBERNT, JANETTE I
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:I
Last Name:ALTENBERNT
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 1:7732 NAPOLEON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8525
Mailing Address - Country:US
Mailing Address - Phone:517-513-2173
Mailing Address - Fax:
Practice Address - Street 1:141 1ST ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8600
Practice Address - Country:US
Practice Address - Phone:517-278-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF10200382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily