Provider Demographics
NPI:1538226972
Name:LYCHE, JANEEN A
Entity type:Individual
Prefix:MRS
First Name:JANEEN
Middle Name:A
Last Name:LYCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13403 VOLVO WAY
Mailing Address - Street 2:MEDICAL SUITE
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3810
Mailing Address - Country:US
Mailing Address - Phone:240-500-3764
Mailing Address - Fax:301-790-2050
Practice Address - Street 1:13403 VOLVO WAY
Practice Address - Street 2:MEDICAL SUITE
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3810
Practice Address - Country:US
Practice Address - Phone:240-500-3764
Practice Address - Fax:301-790-2050
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027028800Medicaid
MD169750ZC81Medicare PIN