Provider Demographics
NPI:1679640882
Name:STOUT, JANICE A (CRNP)
Entity Type:Individual
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First Name:JANICE
Middle Name:A
Last Name:STOUT
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Gender:F
Credentials:CRNP
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Mailing Address - Street 1:1501 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2309
Mailing Address - Country:US
Mailing Address - Phone:610-821-2828
Mailing Address - Fax:610-821-7915
Practice Address - Street 1:401 N 17TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5034
Practice Address - Country:US
Practice Address - Phone:610-434-5300
Practice Address - Fax:610-434-9901
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-11-07
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Provider Licenses
StateLicense IDTaxonomies
PATP006121B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P14219Medicare UPIN