Provider Demographics
NPI:1841413028
Name:GUNN, ELAINE JEAN (RN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:JEAN
Last Name:GUNN
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 1:282 E BONITA DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3006
Mailing Address - Country:US
Mailing Address - Phone:805-577-0830
Mailing Address - Fax:805-581-2852
Practice Address - Street 1:3150 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3940
Practice Address - Country:US
Practice Address - Phone:805-577-0830
Practice Address - Fax:805-581-2852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653033163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult