MEDICARE: MS. JANICE ANN OLIVER RN, PHN

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	163WC0400X	Case Management Registered Nurse	786506	CA

General Provider Information

NPI Number	:	1396367140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE ANN OLIVER RN, PHN

Provider Business Mailing Address
First Line	:	4393 DATE AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6412
Country	:	US
Telephone Number	:	619-518-4812
Fax Number	:

Provider Business Practice Location Address
First Line	:	4393 DATE AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6412
Country	:	US
Telephone Number	:	619-518-4812
Fax Number	:

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

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	05/15/2020

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