Provider Demographics
NPI:1104021690
Name:SARTELL, JANICE M (PA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:SARTELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0802
Mailing Address - Country:US
Mailing Address - Phone:814-676-5444
Mailing Address - Fax:814-676-0342
Practice Address - Street 1:1 PARK WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:814-676-5444
Practice Address - Fax:814-676-0342
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008266363A00000X
FLPA9104678363A00000X
PAOA003229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008266OtherLICENSE