Provider Demographics
NPI:1316116932
Name:BIRCH, JENNIFER ALICE (NP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ALICE
Last Name:BIRCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S RAYMOND AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3206
Mailing Address - Country:US
Mailing Address - Phone:626-535-9552
Mailing Address - Fax:626-535-9505
Practice Address - Street 1:630 S RAYMOND AVE UNIT 301
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3206
Practice Address - Country:US
Practice Address - Phone:626-535-9552
Practice Address - Fax:626-535-9505
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559716363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care