Healthcare Provider Details

I. General information

NPI: 1942666433
Provider Name (Legal Business Name): JENNIFER MONIQUE ECHOLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 WAYNE ST
POMONA CA
91767-3518
US

IV. Provider business mailing address

1806 WAYNE ST
POMONA CA
91767-3518
US

V. Phone/Fax

Practice location:
  • Phone: 323-485-8904
  • Fax: 909-624-6460
Mailing address:
  • Phone: 323-485-8904
  • Fax: 909-624-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number849161
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number849161
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number849161
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number849161
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number849161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: