Healthcare Provider Details

I. General information

NPI: 1063907137
Provider Name (Legal Business Name): JANEE MISKELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 08/23/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6388 STOCKTON BLVD 485
SACRAMENTO CA
95823
US

IV. Provider business mailing address

2300 NUCLA WAY
SACRAMENTO CA
95834-1313
US

V. Phone/Fax

Practice location:
  • Phone: 916-907-3205
  • Fax:
Mailing address:
  • Phone: 209-568-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: