Provider Demographics
NPI:1780610691
Name:HANEY, JANET MARIE (RN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:MARIE
Last Name:HANEY
Suffix:
Gender:F
Credentials:RN FNP-BC
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Mailing Address - Street 1:1169 COUNTY ROAD 836
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-4507
Mailing Address - Country:US
Mailing Address - Phone:936-248-4673
Mailing Address - Fax:936-248-4646
Practice Address - Street 1:157 WALL ST
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-5413
Practice Address - Country:US
Practice Address - Phone:936-248-4673
Practice Address - Fax:936-248-4646
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX562803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ62091Medicare UPIN