Basic Information
| Provider Information | |||||||||
| NPI: | 1689949539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOSEK | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 SHALLOW RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210093016 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4863 PULASKI HWY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PERRYVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219031623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106429172 | ||||||||
| FaxNumber: | 4106429176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2012 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0004688 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.