Basic Information
| Provider Information | |||||||||
| NPI: | 1508280868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUA | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 COMMERCE ST STE 700 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372011835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4473514188 | ||||||||
| FaxNumber: | 8557375542 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 E COLORADO BLVD STE 600 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447351418 | ||||||||
| FaxNumber: | 8557375542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2014 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 174942-30 | WI | N | Nursing Service Providers | Registered Nurse | 363L00000X | 5776-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.