=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679883359
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN ANN JUST RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2010
-----------------------------------------------------
Last Update Date | 10/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10474 GORSUCH RD.
-----------------------------------------------------
City | GALENA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-537-4730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10474 GORSUCH RD.
-----------------------------------------------------
City | GALENA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-537-4730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | RN 130524-COA1
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------