Provider Demographics
NPI:1881677086
Name:HARRISON, JEANETTE MARY (MSN, CCNS)
Entity Type:Individual
Prefix:MISS
First Name:JEANETTE
Middle Name:MARY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MSN, CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 DUNBLANE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1015
Mailing Address - Country:US
Mailing Address - Phone:916-703-3505
Mailing Address - Fax:916-734-1656
Practice Address - Street 1:2315 STOCKTON BLVD ROOM 4302
Practice Address - Street 2:UC DAVIS, MEDICAL CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-703-3505
Practice Address - Fax:916-734-1656
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN377552163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care