Healthcare Provider Details

I. General information

NPI: 1548616956
Provider Name (Legal Business Name): CAROLINE FRUSHOUR N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 E 7TH ST
LONG BEACH CA
90804-4327
US

IV. Provider business mailing address

4540 E 7TH ST
LONG BEACH CA
90804-4327
US

V. Phone/Fax

Practice location:
  • Phone: 562-344-1150
  • Fax:
Mailing address:
  • Phone: 562-344-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95004286
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95004286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: