Provider Demographics
NPI:1659759439
Name:LANNON, JENNIFER (FDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LANNON
Suffix:
Gender:F
Credentials:FDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 GRAVES AVE
Mailing Address - Street 2:UNIT 15
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5131
Mailing Address - Country:US
Mailing Address - Phone:619-884-7384
Mailing Address - Fax:
Practice Address - Street 1:8731 GRAVES AVE
Practice Address - Street 2:UNIT 15
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5131
Practice Address - Country:US
Practice Address - Phone:619-884-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator