Provider Demographics
NPI:1104598689
Name:KOTHE, JANELLE MACKENZIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:MACKENZIE
Last Name:KOTHE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2104 HARRISBURG PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3626
Mailing Address - Fax:717-544-3628
Practice Address - Street 1:2104 HARRISBURG PIKE STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3626
Practice Address - Fax:717-544-3628
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2022-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA063178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant