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General NPI Number Information
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NPI Number | 1710130042
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Entity Type | Individual
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Provider Name | CARMEN STOREY AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 15364 AVENIDA ANILLO
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4108
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Country | US
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Telephone | 951-388-4428
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Fax |
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Provider Business Mailing Address
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Address Line | 15364 AVENIDA ANILLO
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4108
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Country | US
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Telephone | 951-388-4428
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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 | 95036315
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 95036315
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 772466
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License Number State | CA
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