Provider Demographics
NPI:1922254358
Name:JANSON, PATRICIA R (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:R
Last Name:JANSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MANETTO HILL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:917-224-2214
Mailing Address - Fax:646-219-4358
Practice Address - Street 1:100 MANETTO HILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:917-224-2214
Practice Address - Fax:646-219-4358
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383131-1163W00000X
NYF400305364SP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult