Provider Demographics
NPI:1730560749
Name:SMITH STASIAK, JANET LYNN (DNP, PMHNP-BC,FNP-BC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:SMITH STASIAK
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC,FNP-BC
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, PMHNP-BC,FNP-BC
Mailing Address - Street 1:PO BOX 20154
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0154
Mailing Address - Country:US
Mailing Address - Phone:301-355-3860
Mailing Address - Fax:410-844-0320
Practice Address - Street 1:405 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4256
Practice Address - Country:US
Practice Address - Phone:301-355-3860
Practice Address - Fax:410-844-0320
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR240227363LF0000X, 363LP0808X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD527020100Medicaid
OH0134933Medicaid