Healthcare Provider Details

I. General information

NPI: 1346583390
Provider Name (Legal Business Name): JOANNE ELIZABETH ARMENIA ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 E CARSON ST
LONG BEACH CA
90808-1706
US

IV. Provider business mailing address

4901 E CARSON ST
LONG BEACH CA
90808-1706
US

V. Phone/Fax

Practice location:
  • Phone: 562-938-4908
  • Fax:
Mailing address:
  • Phone: 562-938-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number301025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: