Provider Demographics
NPI:1982075859
Name:LAM, JEANIE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JEANIE
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 TALBERT AVE STE 301&302
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-965-2543
Mailing Address - Fax:714-965-2593
Practice Address - Street 1:9900 TALBERT AVE STE 301&302
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-965-2500
Practice Address - Fax:714-965-2593
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily