Provider Demographics
NPI:1982112587
Name:MAAG, JANIS (NP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:MAAG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:
Other - Last Name:PITCHFORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:544 E 1200 S
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4497
Mailing Address - Country:US
Mailing Address - Phone:801-397-4900
Mailing Address - Fax:
Practice Address - Street 1:544 E 1200 S
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4497
Practice Address - Country:US
Practice Address - Phone:435-749-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5151861-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner