Provider Demographics
NPI:1831185339
Name:DOUGLAS, JANET (ARNP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ADAMS ST NE
Mailing Address - Street 2:APT 3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1255
Mailing Address - Country:US
Mailing Address - Phone:505-265-5462
Mailing Address - Fax:
Practice Address - Street 1:1217 1ST ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1529
Practice Address - Country:US
Practice Address - Phone:505-242-4644
Practice Address - Fax:505-242-3531
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS171814Medicare PIN
KS171810Medicare PIN
KS171815Medicare PIN
KS171813Medicare PIN