MEDICARE: MS. JENNIFER ALICE BIRCH N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	559716	CA

General Provider Information

NPI Number	:	1316116932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ALICE BIRCH N.P.

Provider Business Mailing Address
First Line	:	630 S RAYMOND AVE UNIT 301
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3206
Country	:	US
Telephone Number	:	626-535-9552
Fax Number	:	626-535-9505

Provider Business Practice Location Address
First Line	:	630 S RAYMOND AVE UNIT 301
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3206
Country	:	US
Telephone Number	:	626-535-9552
Fax Number	:	626-535-9505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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