Provider Demographics
NPI:1114011053
Name:CRYAN, JANA MARIE (CMN)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:MARIE
Last Name:CRYAN
Suffix:
Gender:F
Credentials:CMN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 PASADENA BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-2414
Mailing Address - Country:US
Mailing Address - Phone:832-203-5523
Mailing Address - Fax:832-203-8416
Practice Address - Street 1:1430 PASADENA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2414
Practice Address - Country:US
Practice Address - Phone:832-203-5523
Practice Address - Fax:832-203-8416
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562241367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX562241OtherNURSING LICENSE