Healthcare Provider Details

I. General information

NPI: 1215666847
Provider Name (Legal Business Name): PSYCHIATRIC NURSING CONSULTANT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

V. Phone/Fax

Practice location:
  • Phone: 619-914-6780
  • Fax:
Mailing address:
  • Phone: 530-768-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LASHAUNDA RENEE JETHRO
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: DNP
Phone: 618-789-1081