Provider Demographics
NPI:1255300778
Name:YANOSCHAK, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:YANOSCHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 20TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1832
Mailing Address - Country:US
Mailing Address - Phone:865-331-4321
Mailing Address - Fax:
Practice Address - Street 1:501 20TH ST STE 503
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1832
Practice Address - Country:US
Practice Address - Phone:865-331-4321
Practice Address - Fax:865-374-2078
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0170382084N0400X
NJ25MA089547002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ056871Medicaid
ME432185000Medicaid
ME432185000Medicaid