Healthcare Provider Details

I. General information

NPI: 1679883359
Provider Name (Legal Business Name): JEAN ANN JUST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 GORSUCH RD.
GALENA OH
43021
US

IV. Provider business mailing address

10474 GORSUCH RD.
GALENA OH
43021
US

V. Phone/Fax

Practice location:
  • Phone: 614-537-4730
  • Fax:
Mailing address:
  • Phone: 614-537-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 130524-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: