MEDICARE: MS. MIN CEN APRN

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	101YM0800X	Mental Health Counselor	95006537	CA
2	363LP2300X	Primary Care Nurse Practitioner	95006537	CA
3	363L00000X	Nurse Practitioner	53-77553-111	KS
4	363LF0000X	Family Nurse Practitioner	NP95006537	CA

General Provider Information

NPI Number	:	1275068801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIN CEN APRN

Provider Business Mailing Address
First Line	:	322 SUNRISE ST
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-4923
Country	:	US
Telephone Number	:	913-752-7002
Fax Number	:	866-997-9757

Provider Business Practice Location Address
First Line	:	322 SUNRISE ST
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-4923
Country	:	US
Telephone Number	:	913-752-7002
Fax Number	:	866-997-9757

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	01/12/2026

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