Provider Demographics
NPI:1033173695
Name:JANORSCHKE, PENNY RENEE (CRNA)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:RENEE
Last Name:JANORSCHKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:RENEE
Other - Last Name:PANCERER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:3701 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2255
Mailing Address - Country:US
Mailing Address - Phone:320-258-3090
Mailing Address - Fax:320-258-3095
Practice Address - Street 1:1406 6TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3305
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-656-7092
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 172804-8367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered