Healthcare Provider Details

I. General information

NPI: 1689109092
Provider Name (Legal Business Name): JENNIFER YEANEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 04/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LOCUST ST
SANTA CRUZ CA
95060-3813
US

IV. Provider business mailing address

PO BOX 542
SANTA CRUZ CA
95061-0542
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax: 831-457-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number780472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: