JANIE PARK (NPI# 1003820010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003820010 |
| Entity Type | Individual |
| Full Name | JANIE PARK |
| Credential | RNFA |
| Practice Address |
604 W Medina Ave Mesa AZ 85210-6848 |
| Practice Telephone | 4805452610 |
| Practice Fax Number | 4805452673 |
| Mailing Telephone | 4805452610 |
| Mailing Fax Number | 4805452673 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
RN 032660 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | BCBS AZ | AZ0169450 | 01 |
| AZ | HEALTHNET AZ | 1Z4903 | 01 |
| Street Address |
604 W MEDINA AVE |
| City | MESA |
| State | AZ |
| Zip Code | 85210-6848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497382501 | Mesa Center for Family Medicine | Internal Medicine | 2034 S Alma School Road, Suite #101, Mesa, AZ 85210 | 2020-03-26 |
| 1780177121 | Jessica Cannata | Speech-Language Pathologist | 2150 S Country Club Rd, Suite 20, Mesa, AZ 85210 | 2018-06-11 |
| 1831680305 | Alexandra Katherine Ebong | Nurse Practitioner | 1950 S. Country Club Drive, Ste 102, Mesa, AZ 85210 | 2018-05-21 |
| 1548762719 | Russell D. Meldrum, M.d. Pllc | Orthopaedic Surgery | 855 W. Southern Ave., #1114, Mesa, AZ 85210 | 2018-03-05 |
| 1023510435 | Denise M Bruno-krupp | Counselor | 1830 S. Alma School Rd. Suite 101, Mesa, AZ 85210 | 2018-03-01 |
| 1609374529 | Gene R Lullo | Social Worker | 1830 S Alma School Rd Suite 101, Mesa, AZ 85210 | 2018-01-25 |
| 1295264000 | Ashley P Smith | Naturopath | 601 S Alma School Rd, Apt 101, Mesa, AZ 85210 | 2017-06-06 |
| 1386184059 | Brittany Johnson | Counselor | 1745 S Alma School Rd Ste 230, Mesa, AZ 85210 | 2017-03-01 |
| 1487190880 | Mesa Valley Modern Dentistry, LLP | Dentist | 1712 S, Country Club Drive, Ste 104, Mesa, AZ 85210 | 2017-01-10 |
| 1821544529 | Sandra Coren | Licensed Practical Nurse | 32 S Mcdonald, Tlc, Mesa, AZ 85210 | 2016-09-01 |
| Find all providers in zip 85210 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790347292 | James M Goldhardt | Physician Assistant | 1400 S Dobson Rd Ste A200, Mesa, AZ 85202-4707 | 2019-07-03 |
| 1801305073 | Panduga Surgical Care, Pllc | Physician Assistant | 4904 S Power Rd Ste 103, Pmb 450, Mesa, AZ 85212-3610 | 2017-09-20 |
| 1114325677 | John David Shull Jr. | Physician Assistant | 1520 S Dobson Rd Ste 305, Mesa, AZ 85202 | 2014-12-16 |
| 1679826051 | Az Richardson Surgical Services, LLC | Physician Assistant | 6417 E Star Valley St, Mesa, AZ 85215-0891 | 2012-10-22 |
| 1508173014 | Karli Elizabeth Vierra | Physician Assistant | 1450 S Dobson Rd Ste 320b, Mesa, AZ 85202-4765 | 2010-09-03 |
| 1023335627 | Shawn Christopher Smith | Physician Assistant | 1432 S. Dobson Road, Suite 501, Mesa, AZ 85202 | 2010-04-23 |
| 1144460221 | April M Cadreau | Physician Assistant | 5235 E Southern Ave Ste D106-159, Mesa, AZ 85206 | 2009-03-02 |
| 1598987505 | Patricia Kim Brown | Physician Assistant | 1002 E. Sorenson St., Mesa, AZ 85203 | 2007-05-02 |
| 1275632788 | Justina D Alphin | Physician Assistant | 7525 E Broadway Rd Ste 3, Mesa, AZ 85208-1156 | 2006-09-21 |
| 1750390803 | Daniel Stephen Blake | Physician Assistant | 1839 E Enrose St, Mesa, AZ 85203-5822 | 2006-08-07 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.