Healthcare Provider Details

I. General information

NPI: 1396258141
Provider Name (Legal Business Name): JENNY MY VU CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 NIGHTINGALE AVE
FOUNTAIN VALLEY CA
92708-7416
US

IV. Provider business mailing address

10260 NIGHTINGALE AVE
FOUNTAIN VALLEY CA
92708-7416
US

V. Phone/Fax

Practice location:
  • Phone: 714-310-7725
  • Fax:
Mailing address:
  • Phone: 714-310-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95007977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: