Healthcare Provider Details

I. General information

NPI: 1477894780
Provider Name (Legal Business Name): STEPHANIE HWA RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

4241 W KLING ST APT 30
BURBANK CA
91505-3721
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-4560
  • Fax: 818-847-3795
Mailing address:
  • Phone: 714-469-3298
  • Fax: 818-847-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number847802
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95000733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: