Provider Demographics
NPI:1699310409
Name:JANKE, KAREN ELIZABETH
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:JANKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:E
Other - Last Name:JANKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AG-ACNP
Mailing Address - Street 1:4149 CHATHAM HILL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1439
Mailing Address - Country:US
Mailing Address - Phone:336-403-1232
Mailing Address - Fax:
Practice Address - Street 1:14085 CROWN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1458
Practice Address - Country:US
Practice Address - Phone:703-763-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012536363LA2100X
VA0024179361363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care