Provider Demographics
NPI:1831425586
Name:MENDES, JANIS MARIE (LISC AC)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:MARIE
Last Name:MENDES
Suffix:
Gender:F
Credentials:LISC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACKSNAKE RD
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4304
Mailing Address - Country:US
Mailing Address - Phone:978-388-9541
Mailing Address - Fax:
Practice Address - Street 1:123 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-1638
Practice Address - Country:US
Practice Address - Phone:978-388-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226757171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist