Provider Demographics
NPI:1861069957
Name:ADVANCED PRACTITIONER MEDICAL GROUP - A PROFESSIONAL NURSING CORP
Entity type:Organization
Organization Name:ADVANCED PRACTITIONER MEDICAL GROUP - A PROFESSIONAL NURSING CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHYLEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:310-292-0117
Mailing Address - Street 1:10570 FOOTHILL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3876
Mailing Address - Country:US
Mailing Address - Phone:909-991-7577
Mailing Address - Fax:909-991-7571
Practice Address - Street 1:10570 FOOTHILL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3876
Practice Address - Country:US
Practice Address - Phone:909-991-7577
Practice Address - Fax:909-991-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty