Basic Information
| Provider Information | |||||||||
| NPI: | 1881666394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISAK | ||||||||
| FirstName: | JANENE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3540 E 46TH ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528073403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5637425900 | ||||||||
| FaxNumber: | 5637425980 | ||||||||
| Practice Location | |||||||||
| Address1: | 3540 E 46TH ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528073403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5637425900 | ||||||||
| FaxNumber: | 5637425980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000687 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 85-000564 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.