Provider Demographics
NPI:1942666433
Name:ECHOLS, JENNIFER MONIQUE (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MONIQUE
Last Name:ECHOLS
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 1:1806 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3518
Mailing Address - Country:US
Mailing Address - Phone:323-485-8904
Mailing Address - Fax:909-624-6460
Practice Address - Street 1:1806 WAYNE ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3518
Practice Address - Country:US
Practice Address - Phone:323-485-8904
Practice Address - Fax:909-624-6460
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA849161163WC0400X, 163WC1500X, 163WH0200X, 163WI0500X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care