Basic Information
| Provider Information | |||||||||
| NPI: | 1063465177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDEN | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 W MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177876440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4665 DOUGLAS CIR NW | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447183673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304891698 | ||||||||
| FaxNumber: | 3304891325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN138870 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0758532 | 05 | OH | MEDICAID | 430012909 | 01 | MEDIARE RAILROAD | OTHER | 000000298786 | 01 | ANTHEM | OTHER |