Provider Demographics
NPI:1366033011
Name:LINN, LURETTE JILL (RN)
Entity Type:Individual
Prefix:
First Name:LURETTE
Middle Name:JILL
Last Name:LINN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 CARMEL VISTA RD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2529
Mailing Address - Country:US
Mailing Address - Phone:858-232-7231
Mailing Address - Fax:
Practice Address - Street 1:12221 CARMEL VISTA RD UNIT 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2529
Practice Address - Country:US
Practice Address - Phone:858-232-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC4682615OtherSECRETARY OF STATE