Basic Information
| Provider Information | |||||||||
| NPI: | 1902453079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUMAS | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | |||||||||
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| Credential: | NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6229 BUTLER AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908052238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626683782 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1322 N AVALON BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907442639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105131300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2019 | ||||||||
| LastUpdateDate: | 08/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN85039 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.