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General NPI Number Information
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NPI Number | 1972172005
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Entity Type | Individual
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Provider Name | KAREN ANN DOUVILLIER FNP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | PACIFIC NEUROSCIENCE INSTITUTE 2125 ARIZONA AVE
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-582-7640
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Fax | 949-364-4290
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Provider Business Mailing Address
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Address Line | 3735 DIAMANTE
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3824
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Country | US
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Telephone | 949-426-1745
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018007
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License Number State | CA
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