Provider Demographics
NPI:1881098770
Name:WILTSE, JANNIS
Entity type:Individual
Prefix:
First Name:JANNIS
Middle Name:
Last Name:WILTSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANNIS
Other - Middle Name:
Other - Last Name:DEFRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3007 NORTH SAGINAW RD.
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-633-1400
Mailing Address - Fax:
Practice Address - Street 1:3007 NORTH SAGINAW RD.
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-633-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704197604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse