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General NPI Number Information
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NPI Number | 1932823101
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Entity Type | Individual
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Provider Name | SUMMER ROSE FELCYN-GHENCO WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 08/20/2023
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Provider Practice Location Address
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Address Line | 30300 CAMINO CAPISTRANO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1304
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Country | US
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Telephone | 949-240-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 28486 LA FALDA
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-4409
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Country | US
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Telephone | 808-366-9919
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95169103
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 95022825
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License Number State | CA
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