MEDICARE: MRS. JANELL DAWN MISSLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency	1092678-1-HCBS	MN

General Provider Information

NPI Number	:	1154823755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANELL DAWN MISSLER

Provider Business Mailing Address
First Line	:	1348 COUNTY ROAD 44
Second Line	:
City	:	SOUTH HAVEN
State	:	MN
Zip	:	55382-9112
Country	:	US
Telephone Number	:	763-464-6701
Fax Number	:	320-274-2419

Provider Business Practice Location Address
First Line	:	1348 COUNTY ROAD 44
Second Line	:
City	:	SOUTH HAVEN
State	:	MN
Zip	:	55382-9112
Country	:	US
Telephone Number	:	763-464-6701
Fax Number	:	320-274-2419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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