Provider Demographics
NPI:1831790054
Name:BACANI, JAN SHARONE (RN)
Entity type:Individual
Prefix:
First Name:JAN SHARONE
Middle Name:
Last Name:BACANI
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 1:7320 SW HUNZIKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2302
Mailing Address - Country:US
Mailing Address - Phone:503-942-3077
Mailing Address - Fax:
Practice Address - Street 1:10690 NE CORNELL RD STE 220
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9224
Practice Address - Country:US
Practice Address - Phone:503-848-5861
Practice Address - Fax:503-848-5863
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRN202008359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse