Provider Demographics
NPI:1881744928
Name:FOLKERTH, JEAN MARY (CRNFA)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARY
Last Name:FOLKERTH
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 VISTA WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4515
Mailing Address - Country:US
Mailing Address - Phone:760-726-2500
Mailing Address - Fax:760-726-3279
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4515
Practice Address - Country:US
Practice Address - Phone:760-726-2500
Practice Address - Fax:760-726-3279
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered