Provider Demographics
NPI:1295796100
Name:POLLETTA, JANICE K (NP)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:K
Last Name:POLLETTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:P
Other - Last Name:KORDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:105W E ST
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-1607
Mailing Address - Country:US
Mailing Address - Phone:661-823-7070
Mailing Address - Fax:661-823-0235
Practice Address - Street 1:105W E ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1607
Practice Address - Country:US
Practice Address - Phone:661-823-7070
Practice Address - Fax:661-823-0235
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158982363L00000X
CANP5001044363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0342581Medicaid
MA0342581Medicaid
MAQX7726Medicare PIN