Provider Demographics
NPI:1124506357
Name:VEST, JANELLE ELIZABETH (AGNP)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:ELIZABETH
Last Name:VEST
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W COLFAX AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1635
Mailing Address - Country:US
Mailing Address - Phone:574-546-1900
Mailing Address - Fax:
Practice Address - Street 1:220 W COLFAX AVE STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1635
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2017037499363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health