MEDICARE: MRS. JANE ANN ANDRUS RN

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	163W00000X	Registered Nurse	569565	TX

General Provider Information

NPI Number	:	1669634960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE ANN ANDRUS RN

Provider Business Mailing Address
First Line	:	1122 FOREST PARK DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-2802
Country	:	US
Telephone Number	:	817-598-0676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 FOREST PARK DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-2802
Country	:	US
Telephone Number	:	817-598-0676
Fax Number	:

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	06/27/2008

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