Provider Demographics
NPI:1447536263
Name:LETUSHKO, JANE (CNM)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LETUSHKO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9653
Mailing Address - Country:US
Mailing Address - Phone:856-874-1114
Mailing Address - Fax:856-874-9555
Practice Address - Street 1:157 ROUTE 73
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9653
Practice Address - Country:US
Practice Address - Phone:856-874-1114
Practice Address - Fax:856-874-9555
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00050000367A00000X
NJ25ME00050001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife