Provider Demographics
NPI:1891134292
Name:MIJERE, JANET (APRN FNP BC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MIJERE
Suffix:
Gender:F
Credentials:APRN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721
Mailing Address - Country:US
Mailing Address - Phone:240-764-6716
Mailing Address - Fax:
Practice Address - Street 1:800 KING FARM BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1136
Practice Address - Country:US
Practice Address - Phone:410-302-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145996363L00000X
DCRN960502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC065773100Medicaid
MD1891134292Medicare UPIN