Basic Information
| Provider Information | |||||||||
| NPI: | 1356537906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANWAY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | KENT | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPANISH FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846601008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018222234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 S MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882033861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057517255 | ||||||||
| FaxNumber: | 5056610075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CNP01177 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.