Provider Demographics
NPI:1780459743
Name:O'CONNELL, JANAE MIKEL
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:MIKEL
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-844-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:100 COMMUNITY DR STE 205
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8987
Practice Address - Country:US
Practice Address - Phone:570-476-2700
Practice Address - Fax:570-895-4332
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN712050163W00000X
PASP029308363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner