Provider Demographics
NPI:1417557653
Name:NASH, JEANNINE ARNETTA
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:ARNETTA
Last Name:NASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 LEMON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1619
Mailing Address - Country:US
Mailing Address - Phone:619-678-1210
Mailing Address - Fax:
Practice Address - Street 1:7614 LEMON AVE STE C
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1619
Practice Address - Country:US
Practice Address - Phone:619-678-1210
Practice Address - Fax:619-872-2485
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator