Provider Demographics
NPI:1194480707
Name:STIEKEMA, JENNIFER LEIGH (DNP, CPNP-BC, MS, RN)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:STIEKEMA
Suffix:
Gender:F
Credentials:DNP, CPNP-BC, MS, RN
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:29525 CANWOOD ST STE 214
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4231
Mailing Address - Country:US
Mailing Address - Phone:818-340-3822
Mailing Address - Fax:
Practice Address - Street 1:29525 CANWOOD ST STE 214
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4231
Practice Address - Country:US
Practice Address - Phone:818-340-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015322208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics