Healthcare Provider Details

I. General information

NPI: 1780233411
Provider Name (Legal Business Name): JANNA CRAYCHEE NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 10/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ORANGE AVE STE 101B
CORONADO CA
92118-1408
US

IV. Provider business mailing address

131 ORANGE AVE STE 101B
SAN DIEGO CA
92118-1408
US

V. Phone/Fax

Practice location:
  • Phone: 619-731-0239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number845922
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4829
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95012677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: