Healthcare Provider Details

I. General information

NPI: 1417505264
Provider Name (Legal Business Name): JENILEE JO POHLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE STE 300
LONG BEACH CA
90804-2157
US

IV. Provider business mailing address

1719 N CONCERTO DR
ANAHEIM CA
92807-2009
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-3009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: