Provider Demographics
NPI:1811103674
Name:PHELAN, JAYNE ALISON (FNP)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:ALISON
Last Name:PHELAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 S WAKE FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4248
Mailing Address - Country:US
Mailing Address - Phone:805-644-4826
Mailing Address - Fax:
Practice Address - Street 1:363 S WAKE FOREST AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4248
Practice Address - Country:US
Practice Address - Phone:805-644-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily