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General NPI Number Information
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NPI Number | 1134283096
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Entity Type | Individual
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Provider Name | JANIS PETRIE ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 04/03/2016
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Provider Practice Location Address
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Address Line | 48844 HIGHWAY 101
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City | BANDON
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State | OR
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Zip | 97411-8232
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Country | US
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Telephone | 541-329-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 48844 HIGHWAY 101
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City | BANDON
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State | OR
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Zip | 97411-8232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 200440305RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200450014NP
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 74552
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 45275
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1335053052
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License Number State | KS
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Taxonomy #6
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 201070011CNS-PP
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License Number State | OR
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