Provider Demographics
NPI:1225302300
Name:WANG, JENESSY LEE (FNP)
Entity Type:Individual
Prefix:
First Name:JENESSY
Middle Name:LEE
Last Name:WANG
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 1:162 S RANCHO SANTA FE RD STE E70-103
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4300
Mailing Address - Country:US
Mailing Address - Phone:858-951-6087
Mailing Address - Fax:833-209-2103
Practice Address - Street 1:162 S RANCHO SANTA FE RD STE E70-103
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:588-951-6087
Practice Address - Fax:833-209-2103
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily