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General NPI Number Information
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NPI Number | 1861069957
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Entity Type | Organization
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Legal Business Name | ADVANCED PRACTITIONER MEDICAL GROUP - A PROFESSIONAL NURSING CORP
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 10570 FOOTHILL BLVD STE 210
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3876
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Country | US
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Telephone | 909-991-7577
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Fax | 909-991-7571
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Provider Business Mailing Address
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Address Line | 10570 FOOTHILL BLVD STE 210
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3876
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Country | US
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Telephone | 909-991-7577
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Fax | 909-991-7571
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SHYLEE B TIAMSON
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Credential | FNP-C
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Telephone | 310-292-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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