Provider Demographics
NPI:1508126251
Name:CHU, JENNIE W (MSN NNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:W
Last Name:CHU
Suffix:
Gender:F
Credentials:MSN NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 VIA TENORIO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3239
Mailing Address - Country:US
Mailing Address - Phone:714-393-4505
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON STREET, HARBOR-UCLA MEDICAL CENTER
Practice Address - Street 2:NEONATOLOGY, DEPARTMENT OF PEDIATRICS
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 21245363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care