Provider Demographics
NPI:1326227646
Name:BELLEFONTAINE, JENNIFER LEE FRANCES (BSCN, RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER LEE
Middle Name:FRANCES
Last Name:BELLEFONTAINE
Suffix:
Gender:F
Credentials:BSCN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 W CHAPMAN AVE
Mailing Address - Street 2:#5109
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1738
Mailing Address - Country:US
Mailing Address - Phone:818-300-7922
Mailing Address - Fax:
Practice Address - Street 1:1900 E LA PALMA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1647
Practice Address - Country:US
Practice Address - Phone:714-399-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698420163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse