Healthcare Provider Details

I. General information

NPI: 1639042211
Provider Name (Legal Business Name): JANNA LANCIAUX RTR,MR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

6061 OLD PHILLIPS RD
NORFOLK VA
23502-2620
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-1239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number285323
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: