Provider Demographics
NPI:1992920599
Name:RADFORD, JANET WORRELL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:WORRELL
Last Name:RADFORD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3617
Mailing Address - Country:US
Mailing Address - Phone:207-799-8166
Mailing Address - Fax:
Practice Address - Street 1:51 MARKET ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3617
Practice Address - Country:US
Practice Address - Phone:207-799-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1753442363LF0000X
MECNP181297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FL003234700Medicaid
MECNP181297OtherMAINE BOARD OF NURSING
FL003234700Medicaid
MECNP181297OtherMAINE BOARD OF NURSING