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General NPI Number Information
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NPI Number | 1568687275
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Entity Type | Individual
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Provider Name | CHRISTAL LA SHAWN FENNELL LVN
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 17223 CERRITOS ST
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City | FONTANA
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State | CA
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Zip | 92336-1584
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Country | US
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Telephone | 909-241-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 10935 TERRA VISTA PKWY APT 83
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6348
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Country | US
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Telephone | 909-484-3968
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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 | VN220919
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License Number State | CA
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