MEDICARE: JANETTE VODHANEL NURSE PRACTICIONER

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	363L00000X	Nurse Practitioner	NP-07885	OH

General Provider Information

NPI Number	:	1811996630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETTE VODHANEL NURSE PRACTICIONER

Provider Business Mailing Address
First Line	:	397 CHURCHILL HUBBARD RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1375
Country	:	US
Telephone Number	:	330-759-6750
Fax Number	:	330-759-6755

Provider Business Practice Location Address
First Line	:	6655 SEVILLE DR
Second Line	:
City	:	CANFIELD
State	:	OH
Zip	:	44406-9143
Country	:	US
Telephone Number	:	330-759-6750
Fax Number	:	330-759-6755

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/19/2013

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