Provider Demographics
NPI:1467220111
Name:JONG, MARIANNA ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:ELIZABETH
Last Name:JONG
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 1:21051 WARNER CENTER LN STE 105
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6532
Mailing Address - Country:US
Mailing Address - Phone:818-251-8344
Mailing Address - Fax:
Practice Address - Street 1:21051 WARNER CENTER LN STE 105
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6532
Practice Address - Country:US
Practice Address - Phone:818-251-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577168163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice