Healthcare Provider Details

I. General information

NPI: 1962866483
Provider Name (Legal Business Name): JAMIE W WU WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N PROSPECT AVE SUITE 203
REDONDO BEACH CA
90277-3041
US

IV. Provider business mailing address

520 N PROSPECT AVE SUITE 203
REDONDO BEACH CA
90277-3041
US

V. Phone/Fax

Practice location:
  • Phone: 310-318-5509
  • Fax:
Mailing address:
  • Phone: 310-311-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95001981
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number792220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: