Healthcare Provider Details

I. General information

NPI: 1871171983
Provider Name (Legal Business Name): JESSICA ANN WASHENKO-BLANK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1111
US

IV. Provider business mailing address

221 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1111
US

V. Phone/Fax

Practice location:
  • Phone: 570-689-1866
  • Fax: 844-569-1525
Mailing address:
  • Phone: 570-689-1866
  • Fax: 844-569-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023571
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: