Provider Demographics
NPI:1861739229
Name:VASQUEZ, JENNIFER LYNETTE (RN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNETTE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNETTE
Other - Last Name:MCGREW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:272 N CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6120
Mailing Address - Country:US
Mailing Address - Phone:559-455-3395
Mailing Address - Fax:
Practice Address - Street 1:272 N CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6120
Practice Address - Country:US
Practice Address - Phone:559-455-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse