Provider Demographics
NPI:1700199122
Name:JANOUSEK, ALBERTA (PA)
Entity type:Individual
Prefix:MRS
First Name:ALBERTA
Middle Name:
Last Name:JANOUSEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 BRIGHTON LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2586
Mailing Address - Country:US
Mailing Address - Phone:269-329-0740
Mailing Address - Fax:
Practice Address - Street 1:2855 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-6105
Practice Address - Country:US
Practice Address - Phone:269-969-0885
Practice Address - Fax:269-964-0885
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363LF0000X364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health