Provider Demographics
NPI:1376270991
Name:MCENTIRE, JEANNE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARIE
Last Name:MCENTIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:33071 SANTIAGO DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1326
Mailing Address - Country:US
Mailing Address - Phone:949-291-9714
Mailing Address - Fax:
Practice Address - Street 1:30210 RANCHO VIEJO RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1574
Practice Address - Country:US
Practice Address - Phone:949-493-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12035363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics