Provider Demographics
NPI:1861838161
Name:MCKIERNAN, JANET T (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:T
Last Name:MCKIERNAN
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:T
Other - Last Name:MARTINO'
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:MAILBOX 419
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:646-888-3260
Mailing Address - Fax:646-888-2700
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:MAILBOX 419
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:646-888-3260
Practice Address - Fax:646-888-2700
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306348363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health