MEDICARE: MRS. SHEVON RACHEL JANSEN MSN, APRN, FNP-BC

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	163W00000X	Registered Nurse	95350082	CA

General Provider Information

NPI Number	:	1881540896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEVON RACHEL JANSEN MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	13634 CUNNING LN
Second Line	:
City	:	LAKESIDE
State	:	CA
Zip	:	92040-4406
Country	:	US
Telephone Number	:	561-455-6952
Fax Number	:

Provider Business Practice Location Address
First Line	:	13634 CUNNING LN
Second Line	:
City	:	LAKESIDE
State	:	CA
Zip	:	92040-4406
Country	:	US
Telephone Number	:	561-455-6952
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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