Provider Demographics
NPI:1396144994
Name:MOUSSEAU, JANELL LEE (RN)
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:LEE
Last Name:MOUSSEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIGHWAY 86 AND TOPAWA RD.
Mailing Address - Street 2:
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-0548
Mailing Address - Country:US
Mailing Address - Phone:520-383-7418
Mailing Address - Fax:520-383-7255
Practice Address - Street 1:HIGHWAY 86 AND TOPAWA RD.
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-0548
Practice Address - Country:US
Practice Address - Phone:520-383-7418
Practice Address - Fax:520-383-7255
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN165619163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN165619OtherARIZONA STATE BOARD OF NURSING