Provider Demographics
NPI:1104940147
Name:JANSON, EVA (FNP)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:JANSON
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:PO BOX 994032
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4032
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:2773 HARRIS ST
Practice Address - Street 2:STE A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4866
Practice Address - Country:US
Practice Address - Phone:707-444-8188
Practice Address - Fax:707-442-0124
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN286396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN286396OtherLICENSE