Provider Demographics
NPI:1942720263
Name:PONTIER BROWN, SHENNA (LVN)
Entity Type:Individual
Prefix:
First Name:SHENNA
Middle Name:
Last Name:PONTIER BROWN
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 1:12031 POUTOUS CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8147
Mailing Address - Country:US
Mailing Address - Phone:951-488-5049
Mailing Address - Fax:
Practice Address - Street 1:12031 POUTOUS CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557
Practice Address - Country:US
Practice Address - Phone:951-488-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN237143164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse