Healthcare Provider Details

I. General information

NPI: 1902676331
Provider Name (Legal Business Name): JANE W. NJOROGE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 URCHIN ST
STOCKTON CA
95206-5923
US

IV. Provider business mailing address

3170 URCHIN ST
STOCKTON CA
95206-5923
US

V. Phone/Fax

Practice location:
  • Phone: 443-824-3964
  • Fax:
Mailing address:
  • Phone: 443-824-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95147659
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG11230040
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: