Provider Demographics
NPI:1366411993
Name:RICHLEN, JANET (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:RICHLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:LUCCARINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 S ROSERA ST
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:WI
Mailing Address - Zip Code:54139-9169
Mailing Address - Country:US
Mailing Address - Phone:920-829-6400
Mailing Address - Fax:920-829-6403
Practice Address - Street 1:200 ROSERA ST
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:WI
Practice Address - Zip Code:54139-9169
Practice Address - Country:US
Practice Address - Phone:920-829-6400
Practice Address - Fax:920-829-6403
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1428-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1346371358OtherLENA PCC NPI
WI11014110Medicaid
WI1851477913OtherCMH NPI
WI41969700Medicaid
WI1851477913OtherCMH NPI
WI521310Medicare Oscar/Certification