Provider Demographics
NPI:1154713790
Name:PROACTIVE CARE NURSING, INC
Entity type:Organization
Organization Name:PROACTIVE CARE NURSING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-332-7016
Mailing Address - Street 1:8692 WAGERS CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5027
Mailing Address - Country:US
Mailing Address - Phone:714-332-7016
Mailing Address - Fax:
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-332-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB233434Medicare UPIN