Provider Demographics
NPI:1528725686
Name:THUKU, JANE WANJIRU
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:WANJIRU
Last Name:THUKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 HERNANDEZ ST
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-3335
Mailing Address - Country:US
Mailing Address - Phone:714-496-4428
Mailing Address - Fax:
Practice Address - Street 1:4314 HERNANDEZ ST
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-3335
Practice Address - Country:US
Practice Address - Phone:714-496-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238473164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty