Provider Demographics
NPI:1942616172
Name:MOBILE ADVANCED NURSING, INC.
Entity Type:Organization
Organization Name:MOBILE ADVANCED NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHOURA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:323-630-2063
Mailing Address - Street 1:15782 MIDWOOD DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3223
Mailing Address - Country:US
Mailing Address - Phone:323-630-2063
Mailing Address - Fax:
Practice Address - Street 1:15782 MIDWOOD DR UNIT 3
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3223
Practice Address - Country:US
Practice Address - Phone:323-630-2063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760746242OtherNPI