Provider Demographics
NPI:1922774694
Name:DEWITT, JANINE MARIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELY PARK BLVD APT 11-4
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1411
Mailing Address - Country:US
Mailing Address - Phone:570-396-1123
Mailing Address - Fax:
Practice Address - Street 1:401 BROAD AVE
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-1611
Practice Address - Country:US
Practice Address - Phone:570-853-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health