Provider Demographics
NPI:1831076587
Name:PESSOA, JANIECE
Entity type:Individual
Prefix:
First Name:JANIECE
Middle Name:
Last Name:PESSOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4405
Mailing Address - Country:US
Mailing Address - Phone:701-290-6685
Mailing Address - Fax:
Practice Address - Street 1:3252 4TH AVE E APT 101
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5069
Practice Address - Country:US
Practice Address - Phone:701-260-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant