MEDICARE: JANICE L PFOTENHAUER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN27929	MT
2	367500000X	Certified Registered Nurse Anesthetist	1-116825	AL
3	367500000X	Certified Registered Nurse Anesthetist	RN196515	GA
4	367500000X	Certified Registered Nurse Anesthetist	551327	TX

General Provider Information

NPI Number	:	1093814816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE L PFOTENHAUER CRNA

Provider Business Mailing Address
First Line	:	4401 RIVERCHASE DR.
Second Line	:	PHENIX CITY
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 ST ANDREWS WAY
Second Line	:	PHENIX CITY
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7413
Country	:	US
Telephone Number	:	334-448-8179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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