Marium Janicke

Primary specialty

Pediatric Registered NurseTaxonomy code 163WP0200X

License

741938 Issued in TX

Practice address

212 Old Grande Blvd Ste A110
Tyler, TX 75703-4256

Phone

(903) 509-3742

NPI assigned

Apr 8, 2020

Last updated

Apr 8, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Epic Health Services, Inc.

  dba Aveanna Healthcare

  • Home Health Agency
  • Tyler, TX
  • NPI 1104062991
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1134748395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 OLD GRANDE BLVD STE A110",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034256",
            "telephone_number": "903-509-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 OLD GRANDE BLVD STE A110",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034256",
            "telephone_number": "903-509-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANICKE",
        "first_name": "MARIUM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "TX",
            "license": "741938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alysia James
• Holly Elaina James
• Jevin Kainikkara James, MD
• Monique James
• Alexander Blake Jamieson II, LVN
• Janus Children Services Inc
• Tina Melamed Jaremko, PHD, CCC-SLP
• Samakti Jariwala
• Shamonica Denise Jarju
• Ann O Jarrel, LCSW

• Pediatric Registered Nurse in Tyler, TX
• Providers in Tyler, TX by specialty
• Pediatric Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.