Healthcare Provider Details

I. General information

NPI: 1568599199
Provider Name (Legal Business Name): JANET PRATT FNP-C, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N LAKE ST
MANISTIQUE MI
49854-1234
US

IV. Provider business mailing address

141N SUNSET BEACH DR
MANISTIQUE MI
49854-8912
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-2144
  • Fax: 906-341-5793
Mailing address:
  • Phone: 906-341-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704159035
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704159035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: