Provider Demographics
NPI:1215504667
Name:COLLETT, JEWEL ANN (RN)
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:ANN
Last Name:COLLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JEWELL
Other - Middle Name:ANN
Other - Last Name:COLLETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:234 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-2304
Mailing Address - Country:US
Mailing Address - Phone:805-710-1907
Mailing Address - Fax:
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-781-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program