Healthcare Provider Details

I. General information

NPI: 1821189556
Provider Name (Legal Business Name): JANICE SHEARER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 LONG BEACH BLVD #200
LONG BEACH CA
90806-1571
US

IV. Provider business mailing address

PO BOX 10818
SAN BERNARDINO CA
92423-0818
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-5653
  • Fax: 562-595-4247
Mailing address:
  • Phone: 909-382-0201
  • Fax: 909-382-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: