Jessie Wackerman
Nurse Practitioner - Acute Care Nurse Practitioner - Gerontology Nurse Practitioner - Adult Health
4101 Mount Cantara Cir
Corona
, California 92882-7942
Jessie Wackerman
Nurse Practitioner - Acute Care Nurse Practitioner - Gerontology Nurse Practitioner - Adult Health
4101 Mount Cantara Cir
Corona
, California 92882-7942
(714) 267-9817
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About
Features
Specialties
- Nurse Practitioner - Acute Care
- Nurse Practitioner - Adult Health
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Jessie Wackerman
- 4101 Mount Cantara Cir
- Corona, CA
- Zip : 92882-7942
- Phone : (714) 267-9817
Second Address
- Jessie Wackerman
- 4101 Mount Cantara Cir
- Corona, CA
- Zip : 92882-7942
- Phone : (714) 267-9817
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Is Jessie Wackerman a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LA2100X | Nurse Practitioner - Acute Care | 95017895 | CA |
| N | 363LA2200X | Nurse Practitioner - Adult Health | 95017895 | CA |
| N | 363LG0600X | Nurse Practitioner - Gerontology | 95017895 | CA |
National Provider Identifier
| NPI | 1053085076 |
|---|---|
| Provider Name | Jessie Wackerman |
| First Address | Corona, CA 92882-7942 |
| Second Address | Corona, CA 92882-7942 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/08/2021 |
| Last Update Date | 03/08/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.