Healthcare Provider Details

I. General information

NPI: 1598961179
Provider Name (Legal Business Name): JAN TAYLOR MCVICKER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17875 SUN WALK CT
SAN DIEGO CA
92127-1370
US

IV. Provider business mailing address

17875 SUN WALK CT
SAN DIEGO CA
92127-1370
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-8772
  • Fax:
Mailing address:
  • Phone: 858-451-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number321973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: