Healthcare Provider Details

I. General information

NPI: 1316951460
Provider Name (Legal Business Name): JENNIFER MCLEAN-MADERA NP,PHN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W HILLCREST DR STE. 100
THOUSAND OAKS CA
91320-2734
US

IV. Provider business mailing address

518 GARDEN ST
SANTA BARBARA CA
93101-1606
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-2445
  • Fax: 805-965-2292
Mailing address:
  • Phone: 805-963-2445
  • Fax: 805-965-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number457700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: