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General NPI Number Information
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NPI Number | 1790714947
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Entity Type | Individual
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Provider Name | JESSICA ANNE WARD PNP
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Gender | Female
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 4650 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-2546
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Fax | 323-361-8068
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Provider Business Mailing Address
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Address Line | 6430 W SUNSET BLVD SUITE 600
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City | LOS ANGELES
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State | CA
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Zip | 90028-7900
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Country | US
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Telephone | 323-361-2337
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Fax | 323-361-8491
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209-005975
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 95043902
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License Number State | CA
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