Provider Demographics
NPI:1023238672
Name:HALLER, JANICE A (PA-C)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:HALLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 N GEORGE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1307
Mailing Address - Country:US
Mailing Address - Phone:717-266-0252
Mailing Address - Fax:717-266-6908
Practice Address - Street 1:4314 N GEORGE STREET EXT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1307
Practice Address - Country:US
Practice Address - Phone:717-266-0252
Practice Address - Fax:717-266-6908
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052072363A00000X
PAOA002932363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant