MEDICARE: JANAI MEYER NUTRITION AND LACTATION, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	10032053	AK
2	261Q00000X	Clinic/Center	10032053	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972976967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANAI MEYER NUTRITION AND LACTATION, LLC

Provider Business Mailing Address
First Line	:	130 CARLANNA LAKE RD LOWR
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5669
Country	:	US
Telephone Number	:	907-220-9920
Fax Number	:	907-220-9925

Provider Business Practice Location Address
First Line	:	130 CARLANNA LAKE RD LOWR
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5669
Country	:	US
Telephone Number	:	907-220-9920
Fax Number	:	907-220-9925

Authorized Official
Title or Position	:	OWNER
Name	:	JANAI MARIE MEYER
Credential	:	RD, IBCLC
Telephone Number	:	907-220-9920

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/13/2015

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