Active NPI
Joan Marie Favor Wallick, BSN
- Registered Nurse
- Los Angeles, CA
National Provider Identifier
1740585744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 376353
- Practice address
- 824 N Hill St
Los Angeles, CA 90012-2321 - Phone
- (909) 762-3606
- NPI assigned
- Jan 21, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 376353 | CA | Primary |
Addresses
Primary practice location
824 N Hill St
Los Angeles, CA 90012-2321
Mailing address
4634 Fox Glen Ave
La Verne, CA 91750-1836
Phone (909) 599-4328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 376353 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1740585744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4634 FOX GLEN AVE",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917501836",
"telephone_number": "909-599-4328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "824 N HILL ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900122321",
"telephone_number": "909-762-3606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAVOR WALLICK",
"first_name": "JOAN",
"middle_name": "MARIE",
"credential": "BSN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-21",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "376353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.