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NPI Code Detail

MEDICARE: EULSON MOONIE LEE FNP

MEDICARE: EULSON MOONIE LEE 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
1363LF0000XFamily Nurse Practitioner95031112CA

General Provider Information

NPI Number : 1841038890
Entity Type Code : Individual
Provider Name (Legal Business Name) : EULSON MOONIE LEE FNP
Provider Business Mailing Address
First Line : 7655 E SILVER DOLLAR LN
Second Line :
City : ANAHEIM
State : CA
Zip : 92808-1355
Country : US
Telephone Number : 949-285-7363
Fax Number :
Provider Business Practice Location Address
First Line : 16100 SAND CANYON AVE STE 240
Second Line :
City : IRVINE
State : CA
Zip : 92618-3724
Country : US
Telephone Number : 949-393-7443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2024
Last Update Date : 07/15/2024

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