Provider Demographics
NPI:1144558503
Name:GUNDERSON, JESSICA LYNN (MS, AOCNP, NP-C, CNS)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:MS, AOCNP, NP-C, CNS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:KOZUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 N PROSPECT AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3036
Mailing Address - Country:US
Mailing Address - Phone:310-750-3300
Mailing Address - Fax:310-379-0587
Practice Address - Street 1:514 N PROSPECT AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3036
Practice Address - Country:US
Practice Address - Phone:310-750-3300
Practice Address - Fax:310-379-0587
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19180363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner