Provider Demographics
NPI:1023238672
Name:HALLER, JANICE A (PA-C)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:HALLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2297
Mailing Address - Country:US
Mailing Address - Phone:717-633-2144
Mailing Address - Fax:717-633-2221
Practice Address - Street 1:2201 BRUNSWICK DR STE 1200
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8350
Practice Address - Country:US
Practice Address - Phone:717-637-0470
Practice Address - Fax:717-637-4987
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002932363AM0700X
PAMA052072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant