Provider Demographics
NPI:1376632471
Name:MATHEWS, JANE ELIZABETH (RN, PMHCNS, NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RN, PMHCNS, NP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:MIKELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PMHCNS, NP
Mailing Address - Street 1:200 E. DEL MAR BLVD.
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2551
Mailing Address - Country:US
Mailing Address - Phone:714-618-8334
Mailing Address - Fax:323-410-1012
Practice Address - Street 1:200 E. DEL MAR BLVD.
Practice Address - Street 2:SUITE 122
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2551
Practice Address - Country:US
Practice Address - Phone:714-618-8334
Practice Address - Fax:323-410-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7136363L00000X
CARN306620363LP0808X
CANP7136363LP0808X
CA306620163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health