Cynthia Michelle Gananian-Jackson, RN

Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Nice, CA

NPI 1891069084 · NPPES record last updated Mar 6, 2012

Key facts

NPI
1891069084
Entity type
Individual (NPI type 1)
Primary specialty
Psychiatric/Mental Health Registered Nurse 163WP0808X
License
RN 309244 (CA)
Practice address
3166 Lakeview Dr.
Nice, CA 95464
Phone
(707) 274-8955
Fax
(707) 274-6791
NPI assigned
Mar 6, 2012
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN 309244CAMDPsychiatric/Mental Health Registered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X RN 309244 CA Yes

Addresses

Primary practice location

3166 Lakeview Dr.
Nice, CA 95464

Mailing address

PO Box 533
Nice, CA 95464-0533
Phone (707) 274-8955

Other providers in Nice, CA

All providers in Nice, CA · Psychiatric/Mental Health Registered Nurse in California

Sources for this page

Verify at the official NPI Registry.