Provider Demographics
NPI:1821853920
Name:JANKAUSKAS, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:JANKAUSKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 MYERS AVE
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2025
Mailing Address - Country:US
Mailing Address - Phone:570-955-6775
Mailing Address - Fax:
Practice Address - Street 1:1132 MYERS AVE
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2025
Practice Address - Country:US
Practice Address - Phone:570-955-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical