Provider Demographics
NPI:1336443563
Name:KIRSCHNER, JOAN C (NP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:KIRSCHNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:C
Other - Last Name:KIRSCHNER-FASARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:P.O. BOX 512717
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0717
Mailing Address - Country:US
Mailing Address - Phone:310-967-1884
Mailing Address - Fax:310-967-1800
Practice Address - Street 1:8700 BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1865
Practice Address - Country:US
Practice Address - Phone:310-423-2077
Practice Address - Fax:310-967-1800
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459766163W00000X
CA19356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse