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General NPI Number Information
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NPI Number | 1366913923
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Entity Type | Individual
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Provider Name | JANICE ENLOE AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 2187 N VICKEY ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-6121
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Country | US
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Telephone | 928-527-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 715 N BEAVER ST STE A
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3141
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Country | US
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Telephone | 928-779-5707
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Fax | 928-779-7897
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 219360
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License Number State | AZ
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