Healthcare Provider Details

I. General information

NPI: 1790235232
Provider Name (Legal Business Name): JENNIFER HORROCKS RNC, NP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER DOTEY

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 CAMINO MANZANAS
THOUSAND OAKS CA
91360-2203
US

IV. Provider business mailing address

727 CAMINO MANZANAS
THOUSAND OAKS CA
91360-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-395-7749
  • Fax:
Mailing address:
  • Phone: 818-395-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number559045
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number559045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: