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General NPI Number Information
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NPI Number | 1336516632
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Entity Type | Individual
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Provider Name | JESSIE WETHERBE F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 8475 S VAN NESS AVE
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City | INGLEWOOD
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State | CA
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Zip | 90305-1562
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Country | US
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Telephone | 310-530-5363
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Fax |
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Provider Business Mailing Address
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Address Line | 7418 W 89TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90045-3419
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Country | US
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Telephone | 310-730-3723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 207V00000X
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95002751
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License Number State | CA
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