Provider Demographics
NPI:1174534044
Name:MAAS, JANEEN DENICE (MD)
Entity type:Individual
Prefix:MS
First Name:JANEEN
Middle Name:DENICE
Last Name:MAAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1421 LUISA ST STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4073
Mailing Address - Country:US
Mailing Address - Phone:505-820-1482
Mailing Address - Fax:505-982-0696
Practice Address - Street 1:1421 LUISA ST STE D
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4073
Practice Address - Country:US
Practice Address - Phone:505-820-1482
Practice Address - Fax:505-982-0696
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM94-92207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20165Medicaid
NM20165Medicaid
NMF90172Medicare UPIN