Provider Demographics
NPI:1356539308
Name:STOCK, JANUS MARIE (RN)
Entity type:Individual
Prefix:
First Name:JANUS
Middle Name:MARIE
Last Name:STOCK
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 1:6706 TAM O SHANTER DR
Mailing Address - Street 2:SPACE 140
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3320
Mailing Address - Country:US
Mailing Address - Phone:209-474-9097
Mailing Address - Fax:
Practice Address - Street 1:1601 LAKE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2436
Practice Address - Country:US
Practice Address - Phone:209-333-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse