Provider Demographics
NPI:1194590125
Name:WAARBROEK, JAMIE FAUVE (PMNHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:FAUVE
Last Name:WAARBROEK
Suffix:
Gender:F
Credentials:PMNHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 LARMONA DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1125
Mailing Address - Country:US
Mailing Address - Phone:213-447-9163
Mailing Address - Fax:
Practice Address - Street 1:2935 LARMONA DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1125
Practice Address - Country:US
Practice Address - Phone:213-447-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2023060642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health