Organization Active NPI

Simply Lavish Health and Wellness Anp-C Nursing Corp

  • Adult Health Nurse Practitioner
  • Glendale, CA
National Provider Identifier
1265254387
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
SIMPLY LAVISH HEALTH AND WELLNESS ANP-C NURSING CORP
Practice address
1137 N Central Ave Apt 313
Glendale, CA 91202-3670
Phone
(314) 873-4485
Fax
(818) 230-2670
NPI assigned
Oct 29, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jenny Lynette Brown, NURSE PRACTITIONERNPI 1063983088
Title
Ceo/Nurse Practitioner
Phone
(314) 873-4485

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X Primary

Addresses

Primary practice location

1137 N Central Ave Apt 313
Glendale, CA 91202-3670

Mailing address

1137 N Central Ave Apt 313
Glendale, CA 91202-3670
Phone (314) 873-4485

Other names 1

  • simply lavish health and wellness anp-c nursing corp Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251006002649 IL Part B Supplier - Clinic/Group Practice 0547767741 Receives reassigned benefits from 1 practitioner
Practice locations: Springfield, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1265254387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 N CENTRAL AVE APT 313",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912023670",
            "telephone_number": "314-873-4485",
            "fax_number": "818-230-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1137 N CENTRAL AVE APT 313",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912023670",
            "telephone_number": "314-873-4485",
            "fax_number": "818-230-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPLY LAVISH HEALTH AND WELLNESS ANP-C NURSING CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JENNY",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "CEO/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "314-873-4485",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "simply lavish health and wellness anp-c nursing corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.