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General NPI Number Information
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NPI Number | 1447769765
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Entity Type | Individual
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Provider Name | JENNIFER JANE HAYNES-CASEY LVN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 2781 W RAMSEY ST STE 3&4
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City | BANNING
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State | CA
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Zip | 92220-3700
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Country | US
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Telephone | 951-417-6612
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Fax |
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Provider Business Mailing Address
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Address Line | 1690 LAKESIDE AVE
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City | BEAUMONT
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State | CA
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Zip | 92223-7157
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Country | US
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Telephone | 951-235-0830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN236665
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License Number State | CA
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