Provider Demographics
NPI:1336795665
Name:STOREY, PRECIOUS JAMIE
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:JAMIE
Last Name:STOREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3448
Mailing Address - Country:US
Mailing Address - Phone:323-603-9756
Mailing Address - Fax:
Practice Address - Street 1:462 EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-3448
Practice Address - Country:US
Practice Address - Phone:323-603-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267319164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse