Basic Information
| Provider Information | |||||||||
| NPI: | 1285636043 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZDANUK | ||||||||
| FirstName: | JANETTE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, FNP, CWS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9700 BRENDEN DR | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761083885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172359957 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 7TH ST | ||||||||
| Address2: | SUITE 121 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761022651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173480425 | ||||||||
| FaxNumber: | 8173480455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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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 | 363LF0000X | 445715 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 445715 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 8F21186 | 01 | TX | MEDICARE ID | OTHER | 01269303 | 01 | TX | AMERIGROUP | OTHER | 1122640-04 | 01 | TX | MEDICAID TPI | OTHER |