Provider Demographics
NPI:1982815452
Name:MENZIES, JEANNINE THERESA (FRNP)
Entity Type:Individual
Prefix:MS
First Name:JEANNINE
Middle Name:THERESA
Last Name:MENZIES
Suffix:
Gender:F
Credentials:FRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 W ALONDRA BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3535
Mailing Address - Country:US
Mailing Address - Phone:310-898-2087
Mailing Address - Fax:
Practice Address - Street 1:1716 W ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3535
Practice Address - Country:US
Practice Address - Phone:310-898-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily