Provider Demographics
NPI:1508909151
Name:NURSE PRACTITIONER SERVICES FOR ADVANCE PRACTICE NURSING INC.
Entity Type:Organization
Organization Name:NURSE PRACTITIONER SERVICES FOR ADVANCE PRACTICE NURSING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:949-842-9353
Mailing Address - Street 1:PO BOX 11691
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5038
Mailing Address - Country:US
Mailing Address - Phone:949-842-9353
Mailing Address - Fax:714-828-1759
Practice Address - Street 1:9431 ALDERBURY ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2855
Practice Address - Country:US
Practice Address - Phone:949-842-9353
Practice Address - Fax:714-828-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP07443Medicare UPIN
CANP10567Medicare ID - Type Unspecified