Healthcare Provider Details

I. General information

NPI: 1437349891
Provider Name (Legal Business Name): JAN COAD PHN/RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 CONROY LN STE 301
ROSEVILLE CA
95661-4156
US

IV. Provider business mailing address

1130 CONROY LN STE 301
ROSEVILLE CA
95661-4156
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-6402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number203164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: