Provider Demographics
NPI:1164856571
Name:LIMPANUKORN, PATTRA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PATTRA
Middle Name:
Last Name:LIMPANUKORN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 N BUSH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2812
Mailing Address - Country:US
Mailing Address - Phone:714-541-8883
Mailing Address - Fax:
Practice Address - Street 1:1714 N BUSH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2812
Practice Address - Country:US
Practice Address - Phone:714-541-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily