Provider Demographics
NPI:1972976967
Name:JANAI MEYER NUTRITION AND LACTATION, LLC
Entity type:Organization
Organization Name:JANAI MEYER NUTRITION AND LACTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANAI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, IBCLC
Authorized Official - Phone:907-220-9920
Mailing Address - Street 1:130 CARLANNA LAKE RD LOWR
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5669
Mailing Address - Country:US
Mailing Address - Phone:907-220-9920
Mailing Address - Fax:907-220-9925
Practice Address - Street 1:130 CARLANNA LAKE RD LOWR
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5669
Practice Address - Country:US
Practice Address - Phone:907-220-9920
Practice Address - Fax:907-220-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10032053261Q00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1003924Medicaid
AK1003924Medicaid