Healthcare Provider Details

I. General information

NPI: 1083081483
Provider Name (Legal Business Name): JANE BLACKWELL HOLLINSHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 WHITTIER BLVD
LOS ANGELES CA
90023-2440
US

IV. Provider business mailing address

3945 WHITTIER BLVD
LOS ANGELES CA
90023-2440
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-1998
  • Fax: 213-217-5396
Mailing address:
  • Phone: 323-265-1998
  • Fax: 213-217-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: