Provider Demographics
NPI:1427654516
Name:JANOFSKI, AMY B (RN, FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:JANOFSKI
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 E LAKE MONTCALM RD
Mailing Address - Street 2:
Mailing Address - City:VESTABURG
Mailing Address - State:MI
Mailing Address - Zip Code:48891-9700
Mailing Address - Country:US
Mailing Address - Phone:989-954-9847
Mailing Address - Fax:
Practice Address - Street 1:322 E WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-9375
Practice Address - Country:US
Practice Address - Phone:989-828-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235227163WE0003X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency