Provider Demographics
NPI:1285698720
Name:NETTLETON, JANET MARIE (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5151 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2436
Mailing Address - Country:US
Mailing Address - Phone:520-803-6644
Mailing Address - Fax:520-459-3193
Practice Address - Street 1:5151 E HWY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-803-6644
Practice Address - Fax:520-459-3193
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ275942085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG30230Medicare UPIN