Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | DP184546 | OR |
NPI | 1083029870 |
---|---|
Provider Name | Dr. Elise Suzan Janowak |
First Address | Grants Pass, OR 97526 |
Second Address | Santa Fe, NM 87505-2143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 22/02/2021 |