Provider Demographics
NPI:1912504515
Name:FONNER, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:FONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:SCHOEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:343 PR 409
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:76251
Mailing Address - Country:US
Mailing Address - Phone:214-717-7432
Mailing Address - Fax:
Practice Address - Street 1:909 8TH ST STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6818
Practice Address - Country:US
Practice Address - Phone:205-896-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse