Basic Information
| Provider Information | |||||||||
| NPI: | 1578718631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACMILLAN | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 E BROWN ST | ||||||||
| Address2: | POCONO HEALTHCARE MANAGEMENT - PROFESSIONAL CENTER | ||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183013006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704763507 | ||||||||
| FaxNumber: | 5704763754 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 VETERANS PL | ||||||||
| Address2: | PMC LEARNING INSTITUTE | ||||||||
| City: | STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183602494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704261688 | ||||||||
| FaxNumber: | 5704261832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2008 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN211935L | PA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.