Provider Demographics
NPI:1790175495
Name:WAINSCOTT, JAN ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:ELLEN
Last Name:WAINSCOTT
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 1:9466 THUNDERBIRD PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3624
Mailing Address - Country:US
Mailing Address - Phone:925-560-1372
Mailing Address - Fax:
Practice Address - Street 1:9466 THUNDERBIRD PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3624
Practice Address - Country:US
Practice Address - Phone:925-560-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397250163W00000X, 163WN0002X, 163WN0003X
CA40485163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA397250OtherRN