Provider Demographics
NPI:1043675747
Name:WREN, JYESHA ISIS (CNM, WHNP, RN)
Entity Type:Individual
Prefix:
First Name:JYESHA
Middle Name:ISIS
Last Name:WREN
Suffix:
Gender:F
Credentials:CNM, WHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 COMSTOCK CIR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2904
Mailing Address - Country:US
Mailing Address - Phone:831-713-6602
Mailing Address - Fax:
Practice Address - Street 1:2721 COMSTOCK CIR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2904
Practice Address - Country:US
Practice Address - Phone:831-713-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003564363LW0102X
CA849517163W00000X
CA235777367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse