Healthcare Provider Details

I. General information

NPI: 1366531915
Provider Name (Legal Business Name): JANINE MARIE WOODBURN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 TODD AVE APT 6
ELLWOOD CITY PA
16117-1145
US

IV. Provider business mailing address

536 TODD AVE APT 6
ELLWOOD CITY PA
16117-1145
US

V. Phone/Fax

Practice location:
  • Phone: 855-740-1921
  • Fax:
Mailing address:
  • Phone: 855-740-1921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP007382
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP007382
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: