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Individual

JANIS PETRIE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
48844 HIGHWAY 101, BANDON, OR 97411-8232
(541) 329-2078
Mailing address
48844 HIGHWAY 101, BANDON, OR 97411-8232

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1335053052
KS
163W00000X
Registered Nurse
45275
KS
163WC1500X
Community Health Registered Nurse
200440305RN
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
74552
KS
363LF0000X
Family Nurse Practitioner
200450014NP
OR
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
201070011CNS-PP
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
R164226
PTAN
OR
Enumeration date
12/21/2006
Last updated
04/03/2016
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