Organization
AGEWELL ADVANCED NURSING PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMONE KAUFMAN NP (PRINCIPAL)
(562) 357-2063
Entity
Organization
Contact information
Practice address
12 BAYBERRY WAY, IRVINE, CA 92612-2727
(562) 357-2063
Mailing address
12 BAYBERRY WAY, IRVINE, CA 92612-2727
(562) 357-2063
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/24/2023
Last updated
10/24/2023
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