Provider Demographics
NPI:1336365444
Name:BLOUIN, JAN LAUREEN (LVN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:LAUREEN
Last Name:BLOUIN
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 1:524 COLUMBUS AVE # 21
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-2802
Mailing Address - Country:US
Mailing Address - Phone:415-399-1196
Mailing Address - Fax:
Practice Address - Street 1:1001 PORTERO AVENUE
Practice Address - Street 2:WARD 95
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-206-3956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225908164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse