Provider Demographics
NPI:1043324403
Name:PASTUSZAK, JANICE P (NP)
Entity Type:Individual
Prefix:PROF
First Name:JANICE
Middle Name:P
Last Name:PASTUSZAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:P
Other - Last Name:PASTUSZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, APRN, BC
Mailing Address - Street 1:1120 PARKER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1004
Mailing Address - Country:US
Mailing Address - Phone:413-782-2990
Mailing Address - Fax:
Practice Address - Street 1:421 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily