Provider Demographics
NPI:1881764504
Name:HUSTON, JANET (CRNFA)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HUSTON
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3969
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-0969
Mailing Address - Country:US
Mailing Address - Phone:503-918-2997
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:1345 ELSER DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1860
Practice Address - Country:US
Practice Address - Phone:503-918-2997
Practice Address - Fax:503-391-7422
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8001222RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276455Medicaid