Provider Demographics
NPI:1265984686
Name:BRENNEMAN, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 VIA SIENA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3933
Mailing Address - Country:US
Mailing Address - Phone:858-761-6141
Mailing Address - Fax:
Practice Address - Street 1:2365 VIA SIENA
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-3933
Practice Address - Country:US
Practice Address - Phone:858-761-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95108134163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95108134OtherREGISTERED NURSE