Healthcare Provider Details

I. General information

NPI: 1225547458
Provider Name (Legal Business Name): JAI LAITINEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JIE CHEN

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 STONE PT
MURRIETA CA
92562-8668
US

IV. Provider business mailing address

20311 STONE PT
MURRIETA CA
92562-8668
US

V. Phone/Fax

Practice location:
  • Phone: 951-813-8767
  • Fax:
Mailing address:
  • Phone: 951-813-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number836069
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP136060
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: