Provider Demographics
NPI:1700274065
Name:PETERS, JANIE
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66608-1244
Mailing Address - Country:US
Mailing Address - Phone:785-354-1777
Mailing Address - Fax:785-354-8577
Practice Address - Street 1:1130 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66608-1244
Practice Address - Country:US
Practice Address - Phone:785-354-1777
Practice Address - Fax:785-354-8577
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201109910AMedicaid
KS068002300OtherMEDICARE PTAN