=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750659793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY SUE-ANNE YUEN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2011
-----------------------------------------------------
Last Update Date | 12/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15034 IMPERIAL HWY
-----------------------------------------------------
City | LA MIRADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90638-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-902-4929
-----------------------------------------------------
Fax | 562-902-8792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15034 IMPERIAL HWY
-----------------------------------------------------
City | LA MIRADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90638-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-902-4929
-----------------------------------------------------
Fax | 562-902-8792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 21204
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 21204
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------