Provider Demographics
NPI:1538201140
Name:HIATT, JANET R (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:R
Last Name:HIATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-1316
Mailing Address - Country:US
Mailing Address - Phone:805-981-5221
Mailing Address - Fax:
Practice Address - Street 1:2240 E GONZALES RD
Practice Address - Street 2:SUITE 140
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8210
Practice Address - Country:US
Practice Address - Phone:805-981-5221
Practice Address - Fax:805-981-5220
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP12498363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health