Provider Demographics
NPI:1376898494
Name:TAJUDEEN, EMILY LANCASTER (ANP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LANCASTER
Last Name:TAJUDEEN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELAINE
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 W CORNELIA AVE
Mailing Address - Street 2:1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2758
Mailing Address - Country:US
Mailing Address - Phone:310-625-0319
Mailing Address - Fax:
Practice Address - Street 1:6043 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5411
Practice Address - Country:US
Practice Address - Phone:323-337-1720
Practice Address - Fax:323-337-1784
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22019363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22019OtherCALIFORNIA FURNISHING LICENSE