Provider Demographics
NPI:1962883421
Name:CLAUDE, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:CLAUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E PINNER ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-3746
Mailing Address - Country:US
Mailing Address - Phone:757-539-5166
Mailing Address - Fax:
Practice Address - Street 1:340 E PINNER ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-3746
Practice Address - Country:US
Practice Address - Phone:757-539-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-15823251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0157209815Medicaid
VA0157210144Medicaid