Provider Demographics
NPI:1649369604
Name:MATHEWS, JANICE L (ACNP, ANP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:ACNP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 FORESTS EDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9428
Mailing Address - Country:US
Mailing Address - Phone:682-465-8185
Mailing Address - Fax:682-465-8185
Practice Address - Street 1:2002 MEDICAL PKWY STE 500
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3268
Practice Address - Country:US
Practice Address - Phone:410-573-6480
Practice Address - Fax:410-573-9413
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436302363LA2200X
TX436308363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00517Medicare UPIN