Provider Demographics
NPI:1760475628
Name:JANKO, MARI E (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARI
Middle Name:E
Last Name:JANKO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:E
Other - Last Name:DEMAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9016
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:16516 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1217
Practice Address - Country:US
Practice Address - Phone:636-458-8400
Practice Address - Fax:636-458-8404
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant