Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 7570 | AZ |
NPI | 1396826699 |
---|---|
Provider Name | Dr. Don Janowski |
First Address | Chandler, AZ 85249-3685 |
Second Address | Chandler, AZ 85249-3685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0946210 | BLUE CROSS/BLUE SHIELD (01) | AZ |