Provider Demographics
NPI:1407908106
Name:NORMAN, JANE (RN-FIRST ASSIST)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:RN-FIRST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-0134
Mailing Address - Country:US
Mailing Address - Phone:618-654-3800
Mailing Address - Fax:618-654-3838
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:STE 328
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-350-9355
Practice Address - Fax:404-350-9069
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN048973163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical