Provider Demographics
NPI:1558595710
Name:HORNE, JAYNE MARY (LVN)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:MARY
Last Name:HORNE
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 1:4015 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7518
Mailing Address - Country:US
Mailing Address - Phone:619-672-1511
Mailing Address - Fax:
Practice Address - Street 1:918 10TH ST APT 2
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2853
Practice Address - Country:US
Practice Address - Phone:619-435-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-03
Last Update Date:2009-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN229993164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse