Provider Demographics
NPI:1871048538
Name:WALRATH, JEANETTE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:MARIE
Last Name:WALRATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:3344 CHAMBERS ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845
Practice Address - Country:US
Practice Address - Phone:607-734-3252
Practice Address - Fax:607-767-0340
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF340863363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics