Provider Demographics
NPI:1114476504
Name:GURTOWSKI, JANINE LOUISE (PA)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:LOUISE
Last Name:GURTOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:
Other - Last Name:UMBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 365
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:484-628-2663
Mailing Address - Fax:484-628-2621
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 365
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:484-628-2663
Practice Address - Fax:484-628-2621
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058517363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical