Provider Demographics
NPI:1538669502
Name:WEBB, MARY JANE (LVN)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3628
Mailing Address - Country:US
Mailing Address - Phone:530-257-2542
Mailing Address - Fax:530-251-5208
Practice Address - Street 1:795 JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3628
Practice Address - Country:US
Practice Address - Phone:530-257-2542
Practice Address - Fax:530-251-5208
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN230954164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse