Provider Demographics
NPI:1225142565
Name:HORNEMAN, RENNIE JEAN (LVN)
Entity Type:Individual
Prefix:MS
First Name:RENNIE
Middle Name:JEAN
Last Name:HORNEMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 GOLD MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92314-9482
Mailing Address - Country:US
Mailing Address - Phone:909-585-0033
Mailing Address - Fax:
Practice Address - Street 1:1085 GOLD MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:BIG BEAR CITY
Practice Address - State:CA
Practice Address - Zip Code:92314-9482
Practice Address - Country:US
Practice Address - Phone:909-585-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN97734164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse