Healthcare Provider Details

I. General information

NPI: 1720097108
Provider Name (Legal Business Name): LYNN JEHLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TELEGRAPH AVE STE 110
BERKELEY CA
94705-1159
US

IV. Provider business mailing address

2850 TELEGRAPH AVE STE 110
BERKELEY CA
94705-1159
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8140
  • Fax: 510-849-0159
Mailing address:
  • Phone: 510-204-8140
  • Fax: 510-849-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: