Provider Demographics
NPI:1629294152
Name:JAYNE, SANDRA R (RN, MSN, ANP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:R
Last Name:JAYNE
Suffix:
Gender:F
Credentials:RN, MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LACKAWANNA AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-2001
Mailing Address - Country:US
Mailing Address - Phone:570-342-7864
Mailing Address - Fax:570-342-7119
Practice Address - Street 1:300 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-2001
Practice Address - Country:US
Practice Address - Phone:570-342-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007063363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health