Provider Demographics
NPI:1992234165
Name:UMANZOR, JEANNIE MICHELLE (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JEANNIE
Middle Name:MICHELLE
Last Name:UMANZOR
Suffix:
Gender:
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22215 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3036
Mailing Address - Country:US
Mailing Address - Phone:661-247-9568
Mailing Address - Fax:213-799-6959
Practice Address - Street 1:6551 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1490
Practice Address - Country:US
Practice Address - Phone:818-765-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007178363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95038181OtherRN LICENSE
CA95007178OtherNURSE PRACTITONER