Individual
ALICIA LEE JANUSZEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-6000
(570) 808-6061
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA053189
PA
363AM0700X
Medical Physician Assistant
MA053189
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232809429008
TRICARE
PA
01
—
50073484
CAPITAL BLUE CROSS
PA
01
—
CA5965
RAILROAD MEDICARE
PA
01
—
P00444524
RR MEDICARE PTAN
PA
Enumeration date
10/10/2007
Last updated
12/30/2020
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