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General NPI Number Information
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NPI Number | 1447456850
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Entity Type | Individual
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Provider Name | JESSELYN JOHNSON RN
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2001 E ORANGETHORPE AVE STE D
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City | PLACENTIA
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State | CA
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Zip | 92870-6759
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Country | US
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Telephone | 714-525-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 13224 NEWPORT AVE APT, 8A
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City | TUSTIN
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State | CA
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Zip | 92780-3401
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Country | US
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Telephone | 714-389-6851
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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 | 163WW0101X
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Taxonomy Name | Ambulatory Women's Health Care Registered Nurse
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License Number | 672766
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License Number State | CA
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