Healthcare Provider Details

I. General information

NPI: 1255300562
Provider Name (Legal Business Name): JACQUELINE D. RYCHNOVSKY PHD, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NAVAL MEDICAL CENTER
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

1848 LAGRANGE ROAD
CHULA VISTA CA
91913-1680
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8234
  • Fax: 619-532-8137
Mailing address:
  • Phone: 619-889-8545
  • Fax: 619-934-4760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: