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Individual

CHARLOTTE NORDSTROM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
661 W 1ST ST STE G, TUSTIN, CA 92780-2939
(714) 665-9890
(714) 665-9891
Mailing address
661 W 1ST ST, TUSTIN, CA 92780-2939
(800) 597-7977

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9500534
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95005354
BOARD OF REGISTERED NURSING
CA
Enumeration date
01/06/2017
Last updated
05/19/2023
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