=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518600436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENERAL HEALTH NURSING PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2022
-----------------------------------------------------
Last Update Date | 04/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W COLORADO ST # C400
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-1161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-900-0466
-----------------------------------------------------
Fax | 855-326-4856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W COLORADO ST # C400
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-1161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-900-0466
-----------------------------------------------------
Fax | 855-326-4856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ISA JO
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 760-900-0466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------