MEDICARE: ANNE JANETTE JURKOWSKI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	327394	CA

General Provider Information

NPI Number	:	1073176681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE JANETTE JURKOWSKI RN

Provider Business Mailing Address
First Line	:	3830 VALLEY CENTRE DR STE 702
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3307
Country	:	US
Telephone Number	:	858-720-0554
Fax Number	:	858-720-0553

Provider Business Practice Location Address
First Line	:	3830 VALLEY CENTRE DR STE 702
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3307
Country	:	US
Telephone Number	:	858-720-0554
Fax Number	:	858-720-0553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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