MEDICARE: JANICE S. WHITESIDE 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	163WC0400X	Case Management Registered Nurse	484734	CA

General Provider Information

NPI Number	:	1467575175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE S. WHITESIDE RN

Provider Business Mailing Address
First Line	:	11484 B AVE
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-2603
Country	:	US
Telephone Number	:	530-886-3638
Fax Number	:	530-886-3613

Provider Business Practice Location Address
First Line	:	11484 B AVE
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-2603
Country	:	US
Telephone Number	:	530-886-3638
Fax Number	:	530-886-3613

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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