MEDICARE: JANE ELIZABETH MATHEWS RN, PMHCNS, NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	7136	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN306620	CA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP7136	CA
4	163W00000X	Registered Nurse	306620	CA

General Provider Information

NPI Number	:	1376632471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE ELIZABETH MATHEWS RN, PMHCNS, NP

Provider Business Mailing Address
First Line	:	200 E. DEL MAR BLVD.
Second Line	:	SUITE 122
City	:	PASADENA
State	:	CA
Zip	:	91105-2551
Country	:	US
Telephone Number	:	714-618-8334
Fax Number	:	323-410-1012

Provider Business Practice Location Address
First Line	:	200 E. DEL MAR BLVD.
Second Line	:	SUITE 122
City	:	PASADENA
State	:	CA
Zip	:	91105-2551
Country	:	US
Telephone Number	:	714-618-8334
Fax Number	:	323-410-1012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/21/2021

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