Healthcare Provider Details

I. General information

NPI: 1184947491
Provider Name (Legal Business Name): DEBORAH LEE JURY RN, MSN, CPNP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 SUNSET BLVD
LOS ANGELES CA
90027
US

IV. Provider business mailing address

1259 BONNIE BRAE ST
HERMOSA BEACH CA
90254-4029
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2822
  • Fax: 323-361-4027
Mailing address:
  • Phone: 310-372-5529
  • Fax: 323-361-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number407447
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number407447
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number407447
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number19
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: