Provider Demographics
NPI:1760852479
Name:WEBSTER, JANE (RN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LOUISE
Other - Last Name:GOFFINET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1157 E LAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1907
Mailing Address - Country:US
Mailing Address - Phone:801-707-3752
Mailing Address - Fax:
Practice Address - Street 1:344 E 100 S
Practice Address - Street 2:STE 301
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1700
Practice Address - Country:US
Practice Address - Phone:801-322-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT220448-3102163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)