Provider Demographics
NPI:1245047281
Name:STANTON, JADEN MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:MICHAEL
Last Name:STANTON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3435
Mailing Address - Country:US
Mailing Address - Phone:816-752-0840
Mailing Address - Fax:
Practice Address - Street 1:1275 8TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5770
Practice Address - Country:US
Practice Address - Phone:707-826-8633
Practice Address - Fax:707-826-6838
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95393549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse