Provider Demographics
NPI:1487370508
Name:FANKMENI, JOHN YOUASHI (A-GNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:YOUASHI
Last Name:FANKMENI
Suffix:
Gender:M
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUMMERTHUR DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4014
Mailing Address - Country:US
Mailing Address - Phone:240-305-9501
Mailing Address - Fax:
Practice Address - Street 1:300 EVERGREEN DR STE 310
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1059
Practice Address - Country:US
Practice Address - Phone:610-579-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP0010588363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology