Healthcare Provider Details

I. General information

NPI: 1124441092
Provider Name (Legal Business Name): JANE VASQUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 COLLINGWOOD BLVD
TOLEDO OH
43610-1173
US

IV. Provider business mailing address

3350 COLLINGWOOD BLVD
TOLEDO OH
43610-1173
US

V. Phone/Fax

Practice location:
  • Phone: 419-255-9585
  • Fax: 419-255-0207
Mailing address:
  • Phone: 419-255-9585
  • Fax: 419-255-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.266494
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.266494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: