Provider Demographics
NPI:1194364737
Name:PEARSON, JUNELLE (RN)
Entity Type:Individual
Prefix:
First Name:JUNELLE
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48653 PASEO TARAZO
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2274
Mailing Address - Country:US
Mailing Address - Phone:760-799-1131
Mailing Address - Fax:
Practice Address - Street 1:48653 PASEO TARAZO
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2274
Practice Address - Country:US
Practice Address - Phone:760-799-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255776163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse