Provider Demographics
NPI:1891986071
Name:STANK, JANELLE MARIE (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:JANELLE
Middle Name:MARIE
Last Name:STANK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 MCCALLUM ST
Mailing Address - Street 2:#12 EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3154
Mailing Address - Country:US
Mailing Address - Phone:215-843-3550
Mailing Address - Fax:
Practice Address - Street 1:228 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1725
Practice Address - Country:US
Practice Address - Phone:610-642-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009384363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP009384OtherCRNP
PASP009384OtherCRNP