Provider Demographics
NPI:1881362887
Name:PAUL, JENNIFER C (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:PAUL
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 1:5251 VINELAND AVE APT 232
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-7005
Mailing Address - Country:US
Mailing Address - Phone:773-550-0853
Mailing Address - Fax:
Practice Address - Street 1:5251 VINELAND AVE APT 232
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-7005
Practice Address - Country:US
Practice Address - Phone:773-550-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95096011163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk