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General NPI Number Information
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NPI Number | 1780233411
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Entity Type | Individual
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Provider Name | JANNA CRAYCHEE NP, CNS
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Gender | Female
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 10/05/2019
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Provider Practice Location Address
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Address Line | 131 ORANGE AVE STE 101B
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City | CORONADO
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State | CA
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Zip | 92118-1408
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Country | US
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Telephone | 619-731-0239
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Fax |
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Provider Business Mailing Address
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Address Line | 131 ORANGE AVE STE 101B
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City | SAN DIEGO
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State | CA
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Zip | 92118-1408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 845922
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 4829
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95012677
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License Number State | CA
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