Provider Demographics
NPI:1104980929
Name:GYESKY, JANETTE JOY (LDM, CPM)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:JOY
Last Name:GYESKY
Suffix:
Gender:F
Credentials:LDM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NE FRANKLIN AVE
Mailing Address - Street 2:STE G.
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4917
Mailing Address - Country:US
Mailing Address - Phone:541-480-1401
Mailing Address - Fax:541-749-2108
Practice Address - Street 1:375 NE FRANKLIN AVE
Practice Address - Street 2:STE G.
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4917
Practice Address - Country:US
Practice Address - Phone:541-480-1401
Practice Address - Fax:541-749-2108
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10112513176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006066Medicaid