Provider Demographics
NPI:1891182002
Name:BURNETT-WRENN, SHETERAH (LVN)
Entity Type:Individual
Prefix:MRS
First Name:SHETERAH
Middle Name:
Last Name:BURNETT-WRENN
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 1:3686 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-1948
Mailing Address - Country:US
Mailing Address - Phone:951-801-2913
Mailing Address - Fax:
Practice Address - Street 1:3686 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-1948
Practice Address - Country:US
Practice Address - Phone:951-801-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279099320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness