Provider Demographics
NPI:1003390519
Name:LE, JENNIFER (RN, NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45210 PANORAMA DR APT 3
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4401
Mailing Address - Country:US
Mailing Address - Phone:619-471-4799
Mailing Address - Fax:
Practice Address - Street 1:49-111 CA-111 #6A
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236
Practice Address - Country:US
Practice Address - Phone:888-743-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN217526163W00000X
CA95176089163WW0101X
CA95010516363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory