Healthcare Provider Details

I. General information

NPI: 1689941064
Provider Name (Legal Business Name): JENNIFER MICHELE HUSON RN, MSN, CPNP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4638 CANYON PARK LN
LA VERNE CA
91750-1864
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2584
  • Fax:
Mailing address:
  • Phone: 909-592-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number546355
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15382
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number2180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: