Healthcare Provider Details

I. General information

NPI: 1528390184
Provider Name (Legal Business Name): JANE HENDRY PCD(DONA), IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 BLOSSOM WOOD DR
SAN JOSE CA
95124-6061
US

IV. Provider business mailing address

5465 BLOSSOM WOOD DR
SAN JOSE CA
95124-6061
US

V. Phone/Fax

Practice location:
  • Phone: 408-568-2326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10993487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: