Healthcare Provider Details

I. General information

NPI: 1730814633
Provider Name (Legal Business Name): JEANINE MARIE LEJUDGE CPNP-PC, PHN, SNSC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N HANDY ST
ORANGE CA
92867-4434
US

IV. Provider business mailing address

1401 N HANDY ST
ORANGE CA
92867-4434
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-5797
  • Fax:
Mailing address:
  • Phone: 714-628-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number95125633
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95021642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: