Healthcare Provider Details

I. General information

NPI: 1891619383
Provider Name (Legal Business Name): MEREDITH JANIEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N COUNTRY CLUB DR
MESA AZ
85201-4108
US

IV. Provider business mailing address

924 N COUNTRY CLUB DR
MESA AZ
85201-4108
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3800
  • Fax:
Mailing address:
  • Phone: 480-969-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number345116
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: