Provider Demographics
NPI:1114590056
Name:MEJIA, JOANNE R (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:R
Last Name:MEJIA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 W ASH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3246
Mailing Address - Country:US
Mailing Address - Phone:626-484-9706
Mailing Address - Fax:
Practice Address - Street 1:17271 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3701
Practice Address - Country:US
Practice Address - Phone:714-531-0966
Practice Address - Fax:714-531-3495
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily