Healthcare Provider Details

I. General information

NPI: 1720125495
Provider Name (Legal Business Name): JENNIFER KLEIN MSN FNP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 E. HWY 20
LUCERNE CA
95458-7885
US

IV. Provider business mailing address

6300 E. HWY 20
LUCERNE CA
95458-7885
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-9299
  • Fax:
Mailing address:
  • Phone: 707-274-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 17190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: