Provider Demographics
NPI:1073176681
Name:JURKOWSKI, ANNE JANETTE (RN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:JANETTE
Last Name:JURKOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 VALLEY CENTRE DR STE 702
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3307
Mailing Address - Country:US
Mailing Address - Phone:858-720-0554
Mailing Address - Fax:858-720-0553
Practice Address - Street 1:3830 VALLEY CENTRE DR STE 702
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3307
Practice Address - Country:US
Practice Address - Phone:858-720-0554
Practice Address - Fax:858-720-0553
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327394163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty