MEDICARE: MRS. JENNIFER JANE BACKER MSN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	480709	CA

General Provider Information

NPI Number	:	1265576755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER JANE BACKER MSN, FNP

Provider Business Mailing Address
First Line	:	2525 GRAND AVE
Second Line	:	ROOM 106
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1765
Country	:	US
Telephone Number	:	562-570-4056
Fax Number	:	562-570-4039

Provider Business Practice Location Address
First Line	:	2525 GRAND AVE
Second Line	:	ROOM 106
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1765
Country	:	US
Telephone Number	:	562-570-4056
Fax Number	:	562-570-4039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/20/2015

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