Provider Demographics
NPI:1508066622
Name:STANCY, JENNETTE LYNN (RN)
Entity Type:Individual
Prefix:MISS
First Name:JENNETTE
Middle Name:LYNN
Last Name:STANCY
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 1:1250 HARBOR BLVD
Mailing Address - Street 2:STE 600
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3453
Mailing Address - Country:US
Mailing Address - Phone:916-501-8488
Mailing Address - Fax:
Practice Address - Street 1:1250 HARBOR BLVD
Practice Address - Street 2:STE 600
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3453
Practice Address - Country:US
Practice Address - Phone:916-501-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594848163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse