Provider Demographics
NPI:1760474803
Name:WALDSTEIN, JANICE LOUISE (DN, ARNP)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LOUISE
Last Name:WALDSTEIN
Suffix:
Gender:F
Credentials:DN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2965
Mailing Address - Country:US
Mailing Address - Phone:715-675-9858
Mailing Address - Fax:715-675-5475
Practice Address - Street 1:719 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2965
Practice Address - Country:US
Practice Address - Phone:715-675-9858
Practice Address - Fax:715-675-5475
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4403-33363LA2200X
FL2636122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538152491Medicaid
FL308257100Medicaid
WI1538152491Medicaid