Provider Demographics
NPI:1265096861
Name:EDQUIST, JENNIFER (RN, MSN, PHN, SNSC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:EDQUIST
Suffix:
Gender:F
Credentials:RN, MSN, PHN, SNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34037 CORKTREE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2959
Mailing Address - Country:US
Mailing Address - Phone:951-515-0806
Mailing Address - Fax:
Practice Address - Street 1:545 CHANEY ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2712
Practice Address - Country:US
Practice Address - Phone:951-285-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA811621163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool