Provider Demographics
NPI:1982039301
Name:CLEARY, JANNA SCOTT (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:SCOTT
Last Name:CLEARY
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 KATE WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6957
Mailing Address - Country:US
Mailing Address - Phone:443-244-8670
Mailing Address - Fax:443-244-8870
Practice Address - Street 1:59 KATE WAGNER RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6957
Practice Address - Country:US
Practice Address - Phone:443-244-8670
Practice Address - Fax:443-244-8870
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178428363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health