Provider Demographics
NPI:1942078332
Name:EDU ADVANCED NURSING, INC
Entity type:Organization
Organization Name:EDU ADVANCED NURSING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THANTERAPHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-835-7355
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-0336
Mailing Address - Country:US
Mailing Address - Phone:818-835-7355
Mailing Address - Fax:
Practice Address - Street 1:3175 OLD CONEJO RD # 200
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2151
Practice Address - Country:US
Practice Address - Phone:818-835-7355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty