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General NPI Number Information
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NPI Number | 1376270991
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Entity Type | Individual
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Provider Name | JEANNE MARIE MCENTIRE NP
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Gender | Female
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 30210 RANCHO VIEJO RD
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1574
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Country | US
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Telephone | 949-493-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 33071 SANTIAGO DR
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City | DANA POINT
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State | CA
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Zip | 92629-1326
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Country | US
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Telephone | 949-291-9714
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 12035
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License Number State | CA
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