Provider Demographics
NPI:1366531915
Name:WOODBURN, JANINE MARIE (CRNP)
Entity type:Individual
Prefix:MS
First Name:JANINE
Middle Name:MARIE
Last Name:WOODBURN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 TODD AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1145
Mailing Address - Country:US
Mailing Address - Phone:855-740-1921
Mailing Address - Fax:
Practice Address - Street 1:536 TODD AVE APT 6
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1145
Practice Address - Country:US
Practice Address - Phone:855-740-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007382363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064382ESKMedicare ID - Type Unspecified
PA72380Medicare UPIN