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General NPI Number Information
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NPI Number | 1508384702
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Entity Type | Individual
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Provider Name | JESSICA SUWAN NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15403 AQUEDUCT LANE
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City | CHINO HILLS
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State | CA
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Zip | 91709
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Country | US
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Telephone | 909-561-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 15403 AQUEDUCT LN
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City | CHINO HILLS
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State | CA
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Zip | 91709-2959
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Country | US
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Telephone | 909-561-8594
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 95005961
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License Number State | CA
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