Provider Demographics
NPI:1902632086
Name:KOHLER, JANNA SHAYE (RN-BSN)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:SHAYE
Last Name:KOHLER
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:SHAYE
Other - Last Name:MEDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-BSN
Mailing Address - Street 1:224 W D. L. INGRAM AVENUE, BLDG. 1408
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:575-904-3612
Mailing Address - Fax:575-784-6329
Practice Address - Street 1:224 W D. L. INGRAM AVENUE, BLDG. 1408
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-904-3612
Practice Address - Fax:575-784-6329
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245403163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse