Healthcare Provider Details

I. General information

NPI: 1508909151
Provider Name (Legal Business Name): NURSE PRACTITIONER SERVICES FOR ADVANCE PRACTICE NURSING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 ALDERBURY ST
CYPRESS CA
90630-2855
US

IV. Provider business mailing address

PO BOX 11691
NEWPORT BEACH CA
92658-5038
US

V. Phone/Fax

Practice location:
  • Phone: 949-842-9353
  • Fax: 714-828-1759
Mailing address:
  • Phone: 949-842-9353
  • Fax: 714-828-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP10567
License Number StateCA

VIII. Authorized Official

Name: JILL SUZANNE SHELTON
Title or Position: PRESIDENT
Credential: NP
Phone: 949-842-9353